Archived: White Gables

White Gables provides personal and nursing care for up to 55 older people, some of whom live with memory loss. The accommodation is a single storey building which is separated into three units. Cedar unit provides mainly residential care. Castle and Cathedral units provide nursing care to people with complex health needs. On the day of the inspection there were 50 people living in the home.

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

At the last inspection we found people’s care plans lacked detail and oral care was not always effective. In addition, we found staff did not fully understand the requirements of the Mental Capacity Act, 2005 and best interests decisions had not always been recorded. At this inspection we found improvements had been made in each of these areas.

People received good care from staff who knew them well and were trained to meet their needs and wishes. There were sufficient numbers of staff, who were safely recruited, to meet people’s needs. The registered manager responded to the views of relatives and was reviewing the deployment of staff at weekends.

People were protected against avoidable harm. Risks to people’s health, safety and welfare had been assessed and plans were in place to minimise identified risks.

People received their medicines as prescribed for them and systems were in place to control and prevent the spread of infection.

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’s privacy and dignity was maintained and staff provided care in a kind and respectful way. People were encouraged to participate in meaningful activities and family and friends, where appropriate, were involved in planning their care.

The home was well managed and there was an open and inclusive culture. Quality assurance systems were effective in highlighting areas for improvement. The registered provider had action plans in place for the refurbishment of some parts of the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement overall (published 17 July 2018).

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

White Gables is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

White Gables is located on the edge of a village on the outskirts of Lincoln. It accommodates up to 55 people many of whom are living with dementia requiring high levels of care and nursing. The accommodation is provided on one floor and the building is separated into three separate units called Cedar, Castle and Cathedral. Cedar provides mainly residential care whilst Castle and Cathedral provides for people requiring nursing care. On the day of the inspection there were 42 people living at the home.

At our last inspection in December 2015 we rated the service good. At this inspection, we rated the service as requires improvement. Safe, caring, and well led remained good; however, effective and responsive required improvement. This is the first time the service has been rated Requires Improvement.

There was a registered manager in place. 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.

Systems and processes were in place to ensure people were protected from abuse and people told us they felt safe at the home. Risk assessments were completed to identify risks to people’s health and safety but care plans did not always reflect the actions required and we found an example of a delay in obtaining a piece of equipment required to improve a person’s safety.

There was a good culture of incident reporting and staff were able to speak up about concerns. Infection risks were controlled and managed well and checks of the premises were in place to maintain the safety of the buildings and equipment. People received their medicines as prescribed and arrangements were in place for the ordering and supply of people’s medicines.

People were supported to have maximum choice and control of their lives. Although staff supported people in the least restrictive way, they did not always have a full understanding of the Mental Capacity Act (2005) and specific best interest decision making was not always documented.

When people required support and encouragement with their eating and drinking, we had some concerns as to whether they were receiving sufficient fluids and whether sufficient steps were taken to maximise their nutritional intake. Improvements could be made to the care of people’s mouths particularly when they were not able to maintain a good oral intake.

People were supported to access health care and staff sought the advice of a specialist healthcare professionals were necessary. They worked well with other services and acted on the advice provided.

Staff were friendly, encouraging and caring in their approach. People and their relatives praised the attitude of staff and their kindness. They protected people’s privacy and dignity and respected their views and choices.

People and their relatives were involved in the development of their care plans. However, some care plans did not contain some key information and the amount of information about their life history and previous interests was sometimes limited.

People’s views were listened to and acted upon and complaints were dealt with responsively and effectively.

The home was well-led by a registered manager. People using the service, their relatives and staff praised the registered manager and the support they provided. People and staff were encouraged to contribute to the development of the service. Effective auditing processes were in place to monitor the quality of the service. The registered manager carried out their role in line with their registration with the CQC.

A relative told us they had looked for a suitable home for a long time before choosing this one. They said they had to, "Take two buses to get there but it was worth it because staff seemed to really care about the people who lived there".

Personal support plans were in place which described the person's preferred routines and there were risk assessments in place for people who were at risk of falling and for those at risk of developing pressure sores.

Menu plans offered people choice and a wide and varied diet. We saw hot and cold drinks being provided for people several times during our visit. There were jugs of water or squash available in peoples' rooms.

A computer system designed to support the management of medicines was in place. This enabled staff to order medicines and check stocks. A hand held device was used to record the medicines administered. Details about people's medicines were also available on paper records in case there was a problem with the computer system.

We reviewed the provider's procedures for recruiting staff and found they had effective systems in place for checking the fitness of staff to care for people. This included checking the qualifications and professional registration of health staff.