The Gables Care Home

The Gables Care Home is a residential care home providing personal care to up to 21 people. At the time of our inspection there were 17 people using the service.

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

Some staff who administered medicines had not received formal training. People were supported by some staff who had not been recruited safely. Audits and quality assurance processes did not identify the concerns that have resulted in breaches of regulations.

We have made recommendations about the following concerns; people did not have access to over the counter medicines known as homely remedies. Staffing levels left people with limited oversight and interactions. Not all staff had received safeguarding training. Staff were not wearing face masks in line with Government guidance and there was no risk assessment to show any rationale for this or how risks to people would be lessened. Action resulting from feedback was not always recorded.

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 told us they were happy and safe. There was evidence that there had been lessons learned from previous inspections. Relationships with health professionals had ensured people received timely support.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 03 May 2022) and there were breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 February 2022 and breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed and good governance.

We carried out this focused inspection to check whether the Warning Notice we previously served in relation to regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led, which contain those requirements.

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 remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Gables Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation safe recruitment and the lack of robust processes to monitor the quality 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The Gables Care Home is a residential care home providing accommodation for persons who require nursing or personal care to up to 21 people. The service provides support to older adults and people living with dementia. At the time of our inspection there were 13 people using the service.

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

Some audits did not identify concerns or drive improvement. Some documents in use had been reviewed as correct when they were not accurate. Systems were not always robust and operated effectively to ensure all regulatory requirements had been fulfilled.

The registered manager did not consistently manage risk to keep people safe. Medicines were not always managed and stored safely or administered as prescribed. The registered manager did not consistently follow robust recruitment procedures.

We were not assured the registered manager was promoting effective infection prevention guidance. Government guidance on social distancing and visiting was not consistently 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. People were supported with their meals and drinks. Staff had to juggle multiple tasks when supporting one person to eat their meal. Improvements had been made in upholding people’s dignity however, one conversation that should have been private took place in a communal area.

Some care plans did not hold the correct information. We have made a recommendation about this. People enjoyed being in the company of staff and sought their company. The registered manager ensured people remained in contact with loved ones and maintained positive relationships.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 09 November 2021) and there were 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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider consider current guidance on infection prevention. At this inspection we found the registered manager had not embedded any changes resulting from the previous recommendation. At our last inspection we recommended that the provider follow best practice on recruitment. Robust recruitment processes were not in place.

This service has been in Special Measures since 14 April 2021. During this inspection the provider demonstrated that some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 28 July 2021 and 02 August 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, dignity and respect, staffing and good governance.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. 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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Gables Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of medicines, infection prevention, keeping people safe and recruitment processed used to employ staff. There was also a breach as record keeping was not consistently managed, lacked oversight and did not promote service improvement.

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 Gables is a residential care home providing personal care and accommodation for up to 21 people. At the time of inspection there were 17 people living in the home. There are 18 single rooms and three shared rooms. There is one large communal area downstairs which serves as the lounge, dining area, office space and staff area. There are three floors with lift and stair access.

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

People told us they felt safe, however the provider failed to demonstrate that risks were consistently monitored, and they had oversight of people’s safety. People lived in a home that did not look visibly clean. Equipment used to support people with their personal care did not look well maintained and hygienic.

Record keeping related to the administration of some medicines was not in place or not consistently completed. Oversight of people did not reflect the care needs identified in people’s care plans. The provider failed to deploy sufficient staff while waiting to employ new housekeeping staff.

Audits failed to either identify concerns or drive improvement. Some documents in use had been reviewed as correct when they were not accurate. Systems were not always robust and operated effectively to ensure all regulatory requirements had been fulfilled.

We were not assured the provider always followed current guidance on the testing of staff for COVID-19. We have made a recommendation about this. The provider did not consistently follow robust recruitment procedures. We have made a recommendation about this.

People’s dignity and privacy was not consistently upheld. People’s personal information was discussed in front of other people. Confidential information was accessible to people in the communal lounge and in a shared bedroom.

People spoke positively about the relationships they had formed with staff. Observations showed people were happy and relaxed in the company of staff. The provider had engaged with people and staff, formally through meetings and through daily interactions. The management team had been working with a range of professionals following the previous inspection in order to meet people's needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was inadequate (supplementary report published 13 April 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 14 April 2021 During this inspection the provider failed to demonstrate that improvements have been made. The service remains rated as inadequate overall and is still in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. It was also in part due to concerns received about areas of concern such as good governance, medicines, the management of risk and staffing. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this report.

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

The provider and registered manager have engaged in the inspection process and taken action to lessen the risks people were exposed to.

The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

We carried out an unannounced comprehensive inspection of this service on 03 February 2021. Breaches of legal requirements were found. We also undertook this inspection to check whether the Warning Notices we previously served in relation to Regulation 10 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The concerns we had about the provider were, failing to have effective oversight of the quality of care, records and the providers failure to ensure people’s dignity and wishes were upheld.

The provider completed an action plan after the last inspection to show what they would do and by when to improve safeguarding, premises and equipment and fit and proper persons employed. The action plan also looked at duty of candour and safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, caring and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Gables Care Home on our website at www.cqc.org.uk.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of risk and medicines. The lack of dignity and respect some people experienced and the poor hygiene standards throughout the home. Staffing levels did not reflect the care needs identified and record keeping was not robust or consistent to provide oversight and drive improvement.

We have taken enforcement action. 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.

The overall rating for this service is ‘Inadequate’ and the service remains ‘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.

The Gables is a residential care home providing personal care and accommodation for up to 21 people. At the time of inspection there were 20 people living in the home. There are 15 single rooms and three shared rooms. There is one large communal area downstairs which serves as the lounge, dining area, office space and staff area. There are three floors in total with lift and stair access.

People's experience of using the service and what we found

People had not always been protected from the risk of avoidable harm. Risks in relation to access to and from the home, access to the kitchen and the use of the lift had not been assessed or mitigated. Not everyone's needs had been assessed properly before admission which meant the provider could not be assured, they were able to meet their needs. People's toenails had not been attended to regularly which meant they may have experienced discomfort and were at risk of potential harm from falls. Fire safety checks had not been completed with sufficient frequency to help ensure people would be protected in the event of a fire. Not all people had access to a call bell which meant they may have been unable to call for support, in a timely way, when in their bedrooms. Some staff had not received essential training in moving and handling to help ensure they could support people safely. Some staff were seen wearing personal protective equipment (PPE) incorrectly.

Not everyone had been involved in decisions about their care. Some people had moved into shared rooms without their agreement or consultation with their relatives. Two of the three shared rooms did not have any privacy screening to help protect people's dignity when receiving personal care. People’s personal information was not always secured. There was a lack of oversight of the quality of care, records and the premises which meant the registered manager could not be confident people were receiving good quality safe care.

Rating at last inspection

The last rating for this service was good (published 25 October 2018.) At this inspection the rating has deteriorated to Inadequate.

Why we inspected

The inspection was prompted in part due to concerns we received about; safe care and treatment, medicines management, lack of access to call bells, moving and handling practice, dignity concerns in relation to shared bedrooms and lack of effective governance. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to; safe care and treatment, safeguarding people, premises and equipment, fit and proper persons, dignity and respect, good governance and duty of candour. We have made recommendations in relation to; recording medicines, staff supervision, adaptations and design and meeting people's communication needs.

In response to serious concerns we identified during inspection, we took enforcement action to impose conditions on the registration of the provider using our urgent powers identified under s.31 of the Health and Social Care Act 2008.

¿ The provider must not admit new residents or readmit residents without written permission from CQC. The provider has agreed to comply with this condition.

¿ The provider must complete a risk assessment in relation to access to the lift for one person and consider all other people who may be at risk. The provider has met this condition.

¿ The provider must review the call bell system to ensure call bells are accessible to residents who can use them and where a person cannot use a call bell alternate arrangements are identified and provided. The provider has met this condition.

¿ The provider must ensure access and egress to the building is secure. The provider has partially met this condition.

¿ The provider must provide suitable moving and handling training to staff identified in the notice of decision. The provider has met this condition.

¿ The provider and registered manager must undertake training in relation to governance and auditing practices. The provider has not yet met this condition but is seeking appropriate training.

Full information about the Care Quality Commission’s (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

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

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 act 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 of 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.

We found the following examples of good practice.

Staff and people living in the home were tested regularly for Covid 19. People who needed help to consent to testing had been supported.

There were notices on the door to advise visitors of the current restrictions due to the pandemic. There was hand gel at the door and a supply of masks for visitors.

When visiting was possible, each visit was managed to ensure the service could manage things safely.

Policies and procedures had been updated to include consideration of Covid 19 risks.

The Gables is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both of which we looked at during this inspection.

A registered manager was 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.

The Gables Care Home registered under a new provider in July 2017. Consequently, this was their first inspection.

People who lived at The Gables and relatives we spoke with told us they were very happy with the care provided and staff were caring, compassionate and supportive. One person said, “They look after me really well and are so kind.” Also, [Relative] is in the hands of people who really care and are so kind.”

During the inspection visit we observed staff being kind and attentive to people in their care. They were caring, patient and respectful. Comments we received confirmed that.

People who lived at the home received their medicines on time and as required. Care records we looked at contained a medication care plan and risk assessment to inform staff about medication details for each individual.

There was a safeguarding procedure document on display. This gave people who lived at the home, visitors and staff information about who to report any concerns to. Staff told us they had received training in safeguarding vulnerable people and records confirmed this.

We found the building was clean and tidy. However, there were storage issues. For example, equipment was left in the hallway and wheelchairs in communal areas. These were potential hazards for people who lived at the home and put their safety at risk.

We have made a recommendation about the environment to ensure the safety of people was maintained and any obstacles and potential hazards were removed to reduce the risk of trips and falls.

Care plans we looked at were informative and up to date. However not all information was correctly recorded or detailed and put people at risk of not receiving the right care. We discussed this with the registered manager who informed us care planning was being reviewed to simplify systems and ensure all information is contained in records of people who lived at the home.

The registered manager completed risk assessments to guide staff about the mitigation of risk to people who lived at The Gables. Completed accident forms with clear documentation about any injuries and measures introduced to reduce their reoccurrence were kept. Furthermore, the registered manager would look for any patterns or trends that would be addressed to ensure people were kept safe.

Staff had been recruited safely, appropriately trained and supported. They had skills and experience required to support people with their care and social needs. One staff member said, “There was good induction training here when we started.”

The service had safe infection control procedures in place and staff had received infection control training. Staff spoken with confirmed they had been provided with protective clothing such as gloves and aprons as required. This reduced the risk of cross infection.

The service had sufficient staffing levels in place to provide support people required. We saw staff showed concern for people’s wellbeing and responded quickly when people required their help.

Care planning followed a person-centred approach and people told us they were involved in this process. We observed staff supported their human rights to good levels of family contact and supported them to meet their diverse needs.

People had been 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 were supported to have access to healthcare professionals and their healthcare needs had been met.

Staff had been recruited safely, appropriately trained and supported. They had skills and experience required to support people with their care and social needs. One staff member said, “There was good induction training here when we started.”

There was a complaints procedure which was made available to people and their family when they commenced using the service. People we spoke with told us they were happy with the support they received from staff and the registered manager and had no complaints.

The management team used a variety of methods to assess and monitor the quality of the service. These included staff and ‘resident’ meetings and satisfaction surveys to seek their views about the service provided.

The registered manager and staff were clear about their roles and responsibilities and were committed to providing a good standard of care and support to people in their care.