The Gables Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

For this key question we assessed 6 quality statements relating to; safe and effective staffing, safe environments, involving people to manage risks, infection prevention and control, safeguarding and medicines optimisation. We found the provider was in breach of the regulations in relation to; safe care and treatment and, fit and proper persons. and good governance. People were not always safe because they did not receive consistent care. We saw unauthorised techniques being used to support people to stand. People assessed as needing pressure relief did not receive this consistently, information to guide staff had not been available on either day of our assessment. Some care records lacked enough detail in relation to nutritional intake and hydration. People were at risk of harm from unmanaged hazards in the premises. This included, exposed wiring, trailing wires, and an obstructed fire exit. At our last inspection we found recruitment was not robust enough to assure us all staff were suitable to work with people. At this assessment we found not enough improvement had been made. People were protected from the risk of abuse by staff who were trained and knowledgeable about how to keep people safe. People received their medicines from trained staff though some improvement could be made to the recording of topical medicines and medicines prescribed for when required. People were protected from the risk of infection by staff, the home was clean and maintained hygienically.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives had confidence their relations received safe care in the home, 1 relative told us "I do think [Name] is safe."

People were supported by staff who understood how to recognise and respond to safeguarding concerns. Staff we spoke with were able to describe how they recognised and responded to concerns.

The provider had processes in place to safeguard people from the risk of abuse and avoidable harm. Staff understood these processes and their training was up to date.

We saw staff using unauthorised moving and handling techniques which placed people at the risk of harm. We have addressed this in the involving people to manage risks topic.

People were not always supported to manage risks safely. We saw staff using unauthorised moving and handling techniques which exposed 1 person to the risk of harm. Staff told us their training had been theoretical and they had not had practical face to face training.

People living in the home told us they received effective support from staff. "All the lads are pleasant, decent people." Feedback from relatives was positive on the management of risk in relation to falls. One relative said, "[Name], she is safe. I have confidence in the staff and I know she has a sensor mat upstairs." A sensor mat is used to alert staff if a person is at risk of falls.

People were not consistently supported to manage risks. Staff could not tell us how often a person needed support to reposition. The risk management plan to guide staff, had not been in the care records. We requested a copy of the care plan from the provider which we received after the site visit. This evidenced staff had not followed the risk management plan in relation to repositioning.

Care records did not always include risk management plans that met people's needs. Risk management plans in relation to diabetes had not been completed, 1 person's moving and handling risk management plans had not been available for staff to refer to.

We found hazards in the environment which could have led to avoidable harm. People had access to a room which was undergoing repairs, some people were exposed to tripping hazards from wires across their bedroom floor. The alarm on the fire exit to indicate someone had opened it was not operative. People had the opportunity to leave the home without being observed or supported.

We spoke with people living in the home, 2 people told us they felt safe there. However a relative raised concerns about their relation having access to a room undergoing repair which was in a hazardous condition.

Arrangements to monitor the safety of the environment and equipment were not always effective. Equipment used to deliver care and treatment was not consistently well maintained for the intended purpose, stored securely and used properly. This placed people at risk of avoidable harm.

The provider acknowledged that their daily walk rounds had not identified the concerns we had found. They planned to complete more thorough checks. During the assessment the most urgent matters were resolved immediately.

We saw staff were sometimes not always able to provide oversight of the communal areas when they were both supporting people. We did not identify any harm.

The provider's staffing assessment identified that 2 staff were needed both day and night. This meant there were times when people could be unobserved in the communal areas. For example, when staff were supporting people who needed 2 staff to meet their care needs. Staff we spoke with felt 2 staff was acceptable for the number of people living in the home at the time.

People were at risk of harm because safe recruitment systems were not followed for all staff. We looked at 5 staff recruitment records and found that some recruitment checks had not been carried out. There were inconsistencies in all of them and there was no evidence that these had been followed up.

We received mixed feedback from relatives, 1 said there were enough staff to meet people's needs and keep them safe. Another relative felt staff were often a little thin on the ground. However, 1 relative told us, "They [staff] seem to be doing everything they can to be comfortable clean. A close knit group of people who take their job seriously". A second relative said, "I have every confidence.’

Cleaning schedules were in place and followed by staff. Cleaning materials were stored safely in line with COSHH guidelines.

We did not ask people for their views, however we noted people's environment was clean and hygienic. Relatives we spoke with did not raise any specific concerns about the cleanliness of the home.

Staff told us they were able to follow the cleaning schedules.

The provider employed enough staff to ensure the home was clean.

People's medicines were managed safely. However, we found some improvement could be made; Not all staff responsible for giving medicines understood why some 'as and when required' medicines should be offered. Protocols to guide staff were not always in place including for pain relief and rescue medicines. The management of topical medicines, including creams could be improved. We did not find evidence of harm.

People received their medicines from trained staff.

Staff who were responsible for administering medicines said they felt confident and had received enough training.