The Gables Private Residential Home

About the service

The Gables Private Residential Home is a residential care home providing personal care and accommodation to people aged 65 and over. The service can support up to 28 people. At the time of our inspection 24 people were using the service.

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

Areas for improvement identified at our last inspection had been addressed. Improvements in the governance and oversight of the home were seen. People were protected from the risk of harm as assessments were undertaken and followed and staff knew the procedure to follow.

People were supported safely by staff as records were up to date and completed. This meant staff had guidance to support people safely. The home was cleaned to a good standard and free from environmental risks.

People were supported by trained staff that were recruited safely and their practice monitored by the management team. People were supported to take their medicines as prescribed.

People were supported to follow their dietary requirements and preferences. Where people were at risk of malnutrition and dehydration this was monitored, and referrals made to the relevant healthcare professionals. People were supported to access health care services. 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, relatives, and staff were encouraged to feedback into the running of the service. Audits were undertaken on a regular basis to monitor the quality of the service and make improvements where needed. The management team worked alongside partner agencies to enhance the support provided to people.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 5 May 2022).

At our last inspection we found breaches of the regulations in relation to safe care and treatment, need for consent and good governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting these regulations.

Why we inspected

We carried out this inspection to follow up on action we told the provider to take at the last inspection. 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 changed from requires improvement to good based on the findings of this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Gables Private Residential Home is a care home providing personal and nursing care to up to 28 people. The service provides support to people aged 65 and over, some of whom were living with dementia. At the time of our inspection there were 24 people using the service. The home is split across two floors with a large garden to the rear.

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

We last inspected the service in September 2020 and at that time we had concerns people were not receiving their medicines safely. The provider had made improvements to staff training and information contained within care plans to ensure people received their medicines in a safe and timely manner.

At our last two inspections we identified the need for a robust system for the assessment and reviewing of potential risks, and through the analysis of accidents and incidents within the service to ensure lessons are learnt. At this inspection we found that this had not been fully implemented.

Staff were not always recruited safely, there was missing information in staff files including criminal records checks.

Staff did not always wear personal protective equipment effectively and the service was not always kept clean.

People were not always protected from the risk of abuse and avoidable harm. Staff were trained in safeguarding and knew how to identify the signs of abuse. The provider was not working within the principals of the mental capacity act and some people were unable to consent to care and treatment.

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 treated with dignity and respect. People and relatives told us they were being actively included in decisions about their care.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 October 2020) and we found multiple breaches of regulations. 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 not enough improvement had been made and the provider remained in breach of regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance). They had further failed to work withing the principals of the Mental Capacity Act and were therefore in breach of Regulation 11 (Need for Consent).

Why we inspected

We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions Safe and well-led.

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 not changed following this inspection.

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

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Private Residential Care Home is a care home providing personal care for up to 28 people aged 65 and over. At the time of the inspection there were 15 people using the service. The service is provided over two floors, with communal facilities being provided on the ground floor.

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

The provider had not developed effective systems to monitor and manage the service, nor were there effective systems to gather and analyse information. This has restricted the overall monitoring of the service and ineffective governance meant there was a lack of management oversight of the service.

Staff were not always encouraged to give feedback at team meetings. This meant that the service lacked different perspectives from staff who provide care and support.

At our last inspection we identified the need for a robust system for the assessment and reviewing of potential risks, and through the analysis of accidents and incidents within the service to ensure lessons are learnt. At this inspection we found that this had not been implemented.

Medicines weren’t always managed and monitored effectively. There was no audit system for weekly and monthly checks and no protocols for medication which was given ‘when required’. This posed a risk to medicine errors not being identified and addressed in a timely manner.

Rating at last inspection

The last rating for this service was requires improvement (published 31 December 2019)

Why we inspected

At our last inspection the service was rated as requires improvement so the inspection took place to ensure that improvements had been made from the action plans provided.

Enforcement

At our last inspection we identified breaches in relation to the assessment and review of potential risks to people, poor leadership oversight and governance of the service to monitor the quality of care being provided. At this inspection we found that there was not enough improvement made to mitigate the concerns and therefore the breaches in regulation have not been met. A warning notice was issued after our previous inspection and at this inspections we found that the actions had not been met.

Full information about 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Gables Private Residential Care Home is a care home providing personal care for up to 28 people aged 65 and over. At the time of the inspection there were 26 people using the service. The service is provided over two floors, with communal facilities being provided on the ground floor.

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

The provider did not have an effective system in place to assess and monitor the service, nor were there effective systems to gather and share information, including good practice guidance. This restricted the development of the service to improve quality outcomes for people. Ineffective governance meant there was a lack of records, and records which were in place were not consistently reviewed or audited.

People’s safety could be improved through the adoption of a robust system for the assessment and reviewing of potential risks, and through the analysis of accidents and incidents within the service to ensure lessons are learnt. Staff training in topics related to the promotion of people’s safety were not up to date.

We have made a recommendation that the provider adopts good practice guidance to improve systems in medicine management to improve systems for the monitoring and recording of medicines.

People’s needs were not kept under review, and their care plans not consistently updated. Staff were instructed to provide specific aspects of personal care on set days, which did not support person centred care and choices.

People were not supported to have maximum control of their lives and staff did not always support them in the least restrictive way possible and in their bests interests; the policies and systems in the service did not fully support this practice. Staff were instructed to provide specific aspects of personal care on set days, which did not support person centred care and choices.

The environment was well-maintained; however, improvements could be made to support people living with dementia to orientate themselves. People’s dietary needs were met, and people had access to a range of health care services.

People or their family members were not involved in the development or review of their care plans, which meant their views and aspirations for their care were not recorded. However, those we spoke with were complimentary about the care and support they received. People spoke favourably about the caring attitude and approach of staff, and the recognition of their independence, privacy and dignity.

Opportunities for people to engage in social activities, develop interests within the service and the wider community had reduced, as the service didn’t currently employ an activity organiser. However, external services were bought in, to provide activities. Staff had limited time to spend with people to engage in conversation or provide activities, which people, family members and staff commented upon. People were confident to raise complaints should they need to. The provider stated they had not received any complaints.

People were supported by staff who received support through supervision. People spoke favourably about the management of the service, stating the management team were approachable and always available to answer any queries. People’s views were sought twice a year through the completion of questionnaires, which showed a high level of satisfaction in the service provided.

Rating at last inspection

The last rating for this service was good (published 15 February 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the assessment and review of potential risks to people, a lack of person centred care and people's involvement in the planning and review of their care, and poor leadership oversight and governance of the service to monitor the quality of care being provided.

Information as to CQC's regulatory response can be found within the action section at the end of this report.

Follow up

We will work with the 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.

There was a registered manager at this service. 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 our last inspection in January 2014 the provider was fully compliant in all areas inspected.

During our inspection visit we observed that staff were friendly, kind and attentive to people. They spent time sitting with people to offer them comfort or stimulation. We observed staff delivering care which met people’s individual needs and which supported them in a respectful and caring manner.

There were training and processes in place for staff to follow to keep people safe and staff followed these. People’s physical and mental health was promoted. Staff were trained to meet the needs of the people they were caring for. Medicines were stored appropriately and were administered and recorded as prescribed.

We saw staff ensured people were comfortable and had their needs met. We saw people were supported in a relaxed and unhurried manner. Staff were caring and communicated well with people. Lunch was the highlight of the day and care was taken to ensure people had time to socialise and to enjoy their food.

Staff focused on people they were caring for rather that the task they were carrying out. Staff knew the people they were caring for and what was important to them. Staff had a good understanding of people’s needs and this was demonstrated in their responses to people and recognition of when people required additional support.

People’s privacy was respected. People had their independence promoted. Where possible they were offered choice on how they wanted their care delivered and were given choices throughout the day.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time. Records we looked at were personalised and included decisions people had made about their care including their likes, dislikes and personal preferences. People were assisted to pursue their interests and hobbies.

The service was managed in an inclusive manner. People and staff had their wishes and knowledge respected. Staff were aware of their roles and responsibilities in relation to people’s care.

We observed a meal time.The meal was well presented and the dining experience was pleasant. People told us they enjoyed all the meals they had and were given choices if there was something they did not like.

We observed people being asked if they wanted their medicines. People told us they could ask for 'pain killers' when they wanted them and knew they would be given to them when needed.

We found not all information was transferred to the care plan as a communication book was used. This could lead to information about a person being lost as it was not recorded in the correct place.

We saw that residents, relatives and staff had been asked their views about the service through quality questionnaires. The information in the questionnaires was being analysed at the time of our visit. However, the provider had already taken action to address issues raised in the questionnaires. For example, training on end of life care and dementia care had been arranged as a result of comments in staff questionnaires. Systems to improve communication between staff and relatives had been introduced in response to comments in relative questionnaires.

Plans were in place to hold 'residents meetings' although these had not taken place at the time of our visit. These meeting will offer people the opportunity to make suggestions about how the service was run.

People's views and experiences about how their care was delivered were being taken into account. Care workers told us how they involved people in reviewing their care. They told us they discussed the planned care with the person and asked them if they were satisfied with the way in which the care was delivered, or if they wished to make any changes.