Gable Court Nursing Home provides personal care, including nursing care to up to 51 people in a purpose built building located in a residential area. At the time of the inspection, 38 people were using the service, most of them had needs relating to their physical health, and some of them had dementia. The service is arranged over three floors and there are garden and patio areas. Most people’s rooms have an attached private bathroom.
The previous registered manager of the home left the service in February 2014. At the time of the inspection, the manager of the home, who had taken up her role in March 2014, had not yet applied to be registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. The situation will be kept under review by us to ensure Gable Court has a registered manager.
Most people who used the service and their relatives told us the service was effective in planning and meeting people’s needs in relation to their health. A person’s relative told us, “one of the staff is brilliant and they knew exactly what to do when [my relative] was going downhill. They made sure they got the treatment they needed.” Records showed staff had worked with health professionals to ensure people’s complex needs were met effectively.
Staff understood their responsibilities in relation to people who may lack the mental capacity to make decisions about their care and support. People’s relatives were involved in making decisions in their best interests. We did not observe any restrictions on people and staff understood their legal responsibilities in relation to the Deprivation of Liberty Safeguards. The service complied with the requirements of the Mental Capacity Act 2005.
People said that staff were kind but very busy. A person’s relative told us that, “staff give people the basic care but have not really had time to get to know them or find out anything about their past life or interests.” People said there were delays in them receiving their meals in their rooms which meant food was not as hot or appetising as it could have been. They also said that their tea and coffee was sometimes not hot. A person told us, “when you are in your room all day, these little things matter.” A person’s relative told us that they had noticed that people did not always receive their care promptly whilst in their rooms upstairs. They said this was especially evident when staff were away from the upper floors taking people to and from activities on the ground floor.
Some people attended a range of activities which took place on the ground floor of the home during the week. They told us they enjoyed them. Most people stayed in bed in their rooms on the first and second floor of the home. Some of these people said they preferred to do this, but other people told us that they felt isolated and bored in their rooms. A person’s relative told us, “it is very quiet upstairs.”
The manager told us that the provider calculated the staffing budget for the home from information she supplied to them on the number of people using the service and their level of need. During the inspection we found that there were insufficient staff to meet people’s needs.
The manager told us she anticipated that new people would be moving into the home and staffing levels would be adjusted accordingly. She said she was looking at the arrangements for activities and how people received their meals and drinks in order to improve people’s experience of the service.
We checked how people’s medicines were managed. We could not be certain that people had consistently received their medicines safely as prescribed. This was because staff had not kept accurate records.
We also spoke with staff and checked the arrangements that were in place to provide them with training and support. Although some staff had received appropriate supervision and training, we found that other staff had not been given all the support they required to deliver people’s care to the required standard.
The provider carried out checks on the quality of the service which had identified areas for improvement. However, there were no clear timescales for the implementation of these changes. There were breaches of health and social care regulations. The action we have asked the provider to take can be found at the back of this report.