We spoke with people who used the service but they were not always able to tell us their views about their care. We relied upon our observations of care, speaking with staff and looking at records to help us understand people's experiences.We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:
' Is the service caring?
' Is the service responsive?
' Is the service safe?
' Is the service effective?
' Is the service well-led?
This is a summary of what we found -
Is the service safe?
The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. An application was made to the local authority in February 2013 regarding a possible deprivation of a person's liberty. No authorisation was required, as the local authority said the home was acting in the person's best interests and no deprivation of liberty was taking place. Staff needed to attend training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure there were proper safeguards in place.
There were effective recruitment and selection processes at the home. Two new members of staff had started at The Gables since our last visit. Recruitment files showed a range of checks were undertaken prior to their employment. This included obtaining references, occupational health clearance and checking the identity of the members of staff. Checks were also made of criminal convictions and inclusion on lists of people unsuitable to work with vulnerable persons. This protected people from the risks associated with unsuitable workers supporting them.
Staffing rotas were maintained at the service. These showed there were enough skilled and experienced staff to meet people's needs. We observed there were three staff on duty during the morning and afternoon/evening during our visit. This reflected typical staff cover at the home. We noted this was sufficient to meet people's needs. For example, helping people manage the evening meal at a relaxed pace.
We observed staff communicated well to ensure people's needs were met. For example, they checked with each other who had been given drinks and whether people had received both courses of the meal. We saw diaries accompanied people when they attended local day services. These were used to record significant information between the home and day services. This helped promote continuity of people's care.
We looked at a range of records as part of this visit. This included care plans, risk assessments, staff rotas, staff recruitment records, training records, audits and monitoring reports. We found the standard of record keeping varied. This meant there could be inconsistencies in people's care. People's personal records were not accurate and fit for purpose. Care plans had not been kept under regular review and updated as necessary. Care plan folders were disorganised and contained much information that could be archived. We found training records had not been kept up to date. This meant they could not be relied upon to show an accurate picture of when staff had attended mandatory and other courses.
Is the service effective?
We found the home had equipment to promote the independence and comfort of people who used the service. This included an adapted bath downstairs, a mobile hoist and ceiling-mounted hoist. There was a stair lift to assist people moving between the ground and first floors. People were protected from unsafe or unsuitable equipment because the provider had ensured equipment was serviced by appropriate contractors. The most recent servicing was carried out in March this year.
Is the service caring?
We observed staff welcomed people back to the home after they returned from day services. People were asked if they would like a drink and then given their choice. People were made comfortable and were free to move around the home. One person went straight to the sensory room and enjoyed playing with brightly coloured balls. We heard staff informed people the evening meal was fish and chips, so they knew what was being prepared for them.
People's needs were assessed but information had not always been updated to ensure it reflected their current circumstances. We looked at two people's care plans. We saw assessments had been undertaken for a range of needs such as mobility and helping people with washing and bathing. In one care plan, some of the information was no longer applicable as the person's needs had changed.
Risk assessments had been written for a range of activities and situations. For example, moving and handling, the likelihood of developing pressure damage and risk of malnutrition. These assessments had not been reviewed on a regular basis to ensure information was kept up to date. This meant the assessments were not used effectively in helping to reduce or control the potential for people to experience harm.
We saw people's risk of malnutrition was assessed using a nationally-recognised tool. However, the manager told us staff had not received all the training they required to use the tool effectively. This meant there was the potential for risk levels to be unreliable if staff did not know how to use the tool in the way it was designed.
Is the service responsive?
The manager and staff said people received good support from the GP surgery and specialist advisers, such as the speech and language therapist and district nursing service. Records were kept of any appointments with or visits from healthcare professionals. This helped to ensure any follow up advice or recommended courses of treatment were noted, to help people keep healthy and well.
Each person had a personal emergency evacuation plan. These identified any support people would need to vacate the premises, such as in the event of a fire. We saw the home had an emergency procedures folder. This contained useful information. For example, staff and headquarters/senior managers' contact details, people's next of kin details and contact numbers of utility providers. This showed there were arrangements in place to deal with foreseeable emergencies.
Is the service well-led?
The provider had a system to regularly assess and monitor the quality of service that people received. However, it was not used effectively at the service to check people received good quality care and support. We found monitoring of the service had not been undertaken monthly by senior management, as expected by the provider. Reports were made available to us of the findings of monitoring visits which took place over the past financial year. This showed there had only been two monitoring visits in twelve months.
We read reports which showed the manager carried out themed audits of practice at the home. These included medication practice, safeguarding and safety, personalised care, treatment and support and involvement and information. We found actions which arose from these audits to improve the service were not always completed.