Archived: The Gables Care Home

At our last comprehensive inspection of the service, in December 2015, we found one breach of legal requirements which related to safe care and treatment, the service was rated Requires Improvement. At this inspection we found improvements had been made and that the service was no longer in breach of any legal requirements, and is now rated Good.

A registered manager was in post. 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.

People told us they felt safe when supported by staff employed by the service. Staff had received training in recognising the signs of potential abuse and how to respond. A safeguarding policy was in place.

Risks had been assessed and actions to mitigate risks had been identified. Accidents and incidents had been monitored and measures put in place to reduce the likelihood of them reoccurring.

There were enough staff on duty to meet people's needs.

Some areas of the home were in need of redecoration and refurbishment to improve the environment, and an action plan was in place. We have made a recommendation about this.

Staff had undertaken training in a range of subjects related to care and safety. Training was up to date, and staff were supported to further their development.

Care Quality Commission (CQC) is required by law to monitor the application of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their 'best interests'. We found the provider was complying with their legal requirements. People's rights to make choices were respected.

Where restrictions on people's liberty were in place to keep them safe, applications had been made to the local authority to grant Deprivation of Liberty Safeguards in line with legal requirements.

People were involved in planning menus, encouraged to prepare meals, and could make drinks and snacks any time they wished. Where people had specific nutritional needs these were assessed and staff had information about how to meet them.

People we spoke with told us they were happy with the care they received. They told us care was planned around their choices and that staff listened to them. People and staff gave us examples about how people's privacy and dignity were upheld. People told us they felt respected.

People's needs had been assessed and specific and detailed care plans had been created to ensure all staff had access to information about people's needs.

People were encouraged to share their feedback. People indicated their satisfaction with the service in a survey in October 2016. The service had not received any formal complaints since our last inspection, but a policy was available to people who used the service.

People and staff told us the service was managed very well. Staff told us they felt listened to and valued. Staff meetings were held regularly. A range of checks were carried out to monitor the quality of the service. Care records were maintained to a good standard and stored securely so they remained confidential.

The Gables is located in Bedlington and provides accommodation for up to 11 people with a mental health condition or learning disability. At the time of the inspection there were nine people living at the service.

A registered manager was in post. 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.

We identified shortfalls in how medicines were managed. We also identified safety concerns relating to the restriction of windows on the first floor. This posed a risk to the safety of people living in the service. We discussed our findings with the manager who agreed that first floor windows would be restricted.

The building was subject to an ongoing plan of maintenance and refurbishment. Some work had been postponed due to other priorities but the continuation of this work was necessary to ensure the premises remained suitable and safe for people living in the service. We noted that a number of improvements had been made.

People told us that they felt safe, and there were safeguarding policies and procedures in place. Staff told us that they knew what to do in the event of any concerns.

Safe recruitment and selection procedures had been followed. Pre-employment checks were carried out to ensure the safety of people living in the home. There were sufficient numbers of staff employed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The registered manager had submitted one DoLS application to the local authority for authorisation. While the service was operating broadly within the principles of the Mental Capacity Act 2005, we found that one decision was not adequately documented. We have made a recommendation that records evidence that care is always provided in line with the Mental Capacity Act 2005.

People were supported with nutrition, and appropriate risk assessments and monitoring was carried out. People told us they were happy with the meals provided. Menus were planned with people living in the service, and reflected their choices and preferences. They were supported to maintain a healthy balanced diet.

Staff received regular training and supervision and an annual appraisal. Training was appropriate to meet the needs of people living in the service. Formal qualifications were supported and staff felt able to progress in their roles.

A variety of activities were available including group and individual sessions with staff. People felt well supported to maintain hobbies and interests and their views were regularly sought regarding the types of activities available.

People’s health needs were met. They were supported to access health services in the community and concerns relating to the health of people were acted upon promptly and appropriate advice sought.

We saw that people were well cared for. Individualised care plans were in place, and these were person centred. People were involved in the planning and evaluation of their care. They told us that they were very happy living in the service. Visiting professionals told us that the standard of care in the home was good, and the people they supported were very satisfied with the care they received.

We had some concerns about the management of the service. The registered manager had carried out audits relating to the safety and cleanliness of the premises and these had not identified some concerns that we had during our inspection. We had not been notified about one event in line with legal requirements. We made a recommendation that the provider ensured that regular audits of the service and records were carried out in line with their own policies and procedures. We noted that there had been an overall improvement in some areas including the systems in place to seek the views of people using the service, relatives, and other stakeholders.

Staff, people and visiting professionals spoke positively about the registered manager and deputy. They felt well supported and found them welcoming and accommodating.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment. You can see what action we told the provider to take at the back of the report.

We considered our findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found:

Is the service safe?

This question was not reviewed. Therefore this question will be answered at a later date.

Is the service effective?

Repairs had been carried out on the premises and the provider had a programme in place for refurbishing the premises to ensure people were provided with a pleasant environment to live in.

Is the service caring?

This question was not reviewed. Therefore this question will be answered at a later date.

Is the service responsive?

This question was not reviewed. Therefore this question will be answered at a later date.

Is the service well-led?

The provider had systems in place to monitor the standards within the home and to gather people's views about the service they received.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

Care records contained risk assessments and instructions on how these risks should be managed. For example, risk assessments were in place for community access, crossing the main road and self-administration of medications.

Systems were in place to make sure that managers and staff learnt from events such as accidents, complaints, concerns and investigations. This reduced the risks to people and helped the service continually improve.

We saw the provider had policies and procedures related to infection control for staff to refer to. However, we found these were not always followed and this could put people at risk of the spread of infections. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of infection control.

We saw equipment in the home was maintained and tested at appropriate intervals. However, we found some areas of the home were showing signs of wear and tear and some repairs had not been carried out. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safety and suitability of the premises.

The CQC monitors the application of the Mental Capacity Act 2005 and the operation of Deprivation of Liberty Safeguards (DoLS) which apply to care homes. DoLS is a legal process used to ensure that no one has their freedom restricted without good cause or proper assessment. There was a policy in place related to people's mental capacity and deprivation of liberty safeguards. There was evidence to show that mental capacity and deprivation of liberty assessments had been made appropriately.

We found that care records were accurate, up to date and reviewed at regular intervals.

Is the service effective?

The staff we spoke with were able to describe the individual needs of the people they cared for and how these needs were met. The service worked well with other agencies and prompt referrals were made to health care professionals which helped ensure people's health care needs were addressed.

People's health and care needs were assessed and the care plans provided staff with information about how each person's care needs should be met.

Is the service caring?

We spoke with five people who used the service and their comments included, "I have no complaints about here. I love my room and like to spend time there," "I came here for six months and then decided to stay," "I like to help with the cooking, dishes and ironing," "I've been here for two years and it's gone by fast. The staff are all fine" and "Everything is fine at The Gables. I'm part of the fixtures and fittings now.

We spoke with a care professional who visited the home and they told us they felt the home was well managed and people were well cared for.

We observed the interactions between staff and the people they cared for. We saw staff interacted well with people, and supported them to maintain their independence and access activities of their choice.

Is the service responsive?

A complaints procedure was in place and people told us they knew how to make a complaint and said they felt appropriate action would be taken. Comments included, "I would have a word with Diane (the manager) if I wasn't happy about something" and "I would tell them if I had concerns or I would write to County Hall but everything is fine here." A book was maintained to record the complaint and the details of the investigation.

We saw prompt referrals were made to health care professionals when required and appropriate training was provided for staff to help meet individual needs.

Is the service well-led?

We saw there was a system in place to monitor people's care records and to ensure appropriate action was taken if there were any concerns. Incidents, accidents and near misses were monitored each month and appropriate action taken to prevent the situation happening again.

Monthly meetings were held with people who lived at the home to discuss the service provided and minutes were recorded. People we spoke with said the manager was very approachable if they had any concerns or issues. Comments included, "We have meetings but I don't bother to go sometimes" and "The staff and the manager are good, I can tell them what I think." The staff on duty told us the manager was always available to offer support and was always ready to listen to any concerns or new ideas they wished to discuss.

We found there were no audits carried out on the health and safety and infection control standards in the home. Also surveys were not issued to gain people's views of the services provided. This meant that people's health and safety were not protected and their views on the service provided may not always be taken into account.

We found that guidance was not always followed in relation to risk of the spread of infection.

We found that some improvements had been made to the premises since our last inspection. Regular water checks had been carried out and recorded in relation to the potential risk of legionella to protect people who lived in the home.

We spoke to five people who lived in the home and they all told us they enjoyed living there and were happy with the facilities provided. Comments included, "Everything is good and I like living here" and "I have everything I need in here."

We were unable to speak to all of the people using the service because of the nature of their condition. We spoke with staff and observed their practices to determine how care and support were carried out. However, we found that arrangements were not in place to deal with foreseeable emergencies.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. Relatives we spoke with were complimentary about the care and support people received. One relative said, 'The care is excellent. It's a little family home and he is so well cared for.'

We saw that people were provided with a choice of adequate nutrition and hydration.

We concluded people were not always cared for in a clean, hygienic environment.

We walked around the premises and found that they were of a suitable design and layout, but not always adequately maintained.

We saw that there were suitable numbers of skilled, trained and experienced staff.