Archived: The Gables Care Home

At the last inspection in February 2016 The Gables were rated as ‘Good’ overall with the safe domain receiving a rating of ‘Requires Improvement’. At the February inspection there was one breach of Regulation 12 (Safe care and treatment). Following the inspection the registered provider wrote to us and sent an action plan saying how and when they intended to make the improvements needed to meet the regulation. The breach of regulation was met at this inspection.

The service had a registered manager in post at this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The registered manager had previously been the business manager at the home and had been in the process of registering when we were last at the home in February 2016. The previous registered manager was still working at the home as part of the care team.

The Gables Care Home accommodates up to 21 people who need accommodation for their personal care needs. The home provides short and long term care. The home is a semi-detached property with bedroom accommodation being located on three floors. Currently there are 15 single rooms and three shared rooms. The upper floors can be accessed via a passenger lift. There is a large communal lounge and dining area and a conservatory. The ground floor communal area had been refurbished and redecorated and the conservatory replaced since our last inspection. There were 19 people living at the home at the time of our inspection with one person occupying a double room to themselves.

We found that improvements had been made to the home since our last inspection and that the issues experienced at the ‘sister’ home were not in place at The Gables.

The management of falls had been a concern at the homes previous inspection. We found that processes were now in place to manage, prevent, record and report falls and potential safeguarding issues.

The management of medicines had recently transferred to an electronic system. Staff had received the appropriate training and were positive about the new system in place. We found that people received their medicines on time and in a safe manner. We made one recommendation regarding the storage of controlled drugs.

The home was fully staffed and staffing levels were not raised as an issue by anyone we spoke with and were observed to be sufficient to meet the assessed needs of the people living in the home.

At the time of our inspection the home were transferring care plans and associated documents to an electronic care planning system. Whilst we found care plans to contain some good information they were difficult to navigate and were not always person centred and reflective of people’s most up to date needs. We have made a recommendation about this.

We found evidence of audits taking place although some areas were not formally audited such as infection prevention control and care planning. We have made a recommendation about this.

Meetings were held for people living in the home, their relatives and staff which meant people had an opportunity to learn about developments in the home and have an input.

The morale and the culture within the home was observed to be positive and staff we spoke with confirmed this to be the case.

We saw evidence that the home maintained the premises and equipment via servicing and appropriate maintenance processes being in place.

We last inspected The Gables Care Home on 24 April 2014 and the service was judged to be fully compliant with the previous regulatory standards.

The Gables Care Home accommodates up to 21 people who need accommodation for their personal care needs. The home provides short and long term care. The home is a semi-detached property with bedroom accommodation being located on three floors. Currently there are 15 single rooms and three shared rooms. The upper floors can be accessed via a passenger lift. There is a large communal lounge and dining area and a conservatory. At the time of our inspection the ground floor of the home was being decorated and we were told that the conservatory was being replaced shortly after our inspection visit.

We found one breach of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2014. This related to safe care and treatment. We also made two recommendations regarding the need for formal infection control audits to take place and to ensure that staff with responsibility for administering medication are aware of the need to observe people taking their medicine.

You can see what action we told the provider to take at the back of the full version of this report.

There were 20 people staying at the home on the first day of the inspection. Sadly one person had passed away who had been receiving end of life care when we returned the following week to complete the inspection visit. We were told that the home operated a waiting list for people who had expressed an interest in living at the home.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. However when we looked at the homes accident and incident book, and care records, we saw that a number of falls had happened at the home that had not been reported to the Local Authority safeguarding team.

All the people we spoke with told us they felt safe at the home.

We looked at how medicines were ordered, stored, administered and recorded. We spoke with the senior carer who had responsibility for administering medication on the first day of the inspection and observed medication being given to people over the lunchtime period.

We observed people being given assistance as they needed it when eating their lunch and that people were offered plenty of drinks, both hot and cold alternatives, throughout the lunchtime period and the day.

We saw that food and fluid charts were in place for those people who needed their diet and hydration monitored. The forms contained good details with liquids measured and a good description of what had been eaten.

People who used the service cited no issues when we discussed consent issues with them.

People told us that staff respected their privacy and treated them with dignity. We observed staff interactions with people during our inspection and found them to be warm and compassionate.

People we spoke with and their relatives told us they knew how to raise issues or make complaints. They also told us they felt confident that any issues raised would be listened to and addressed.

We examined the care files of five people, who lived at The Gables Care Home. We found documentary evidence to show that people had their care needs assessed both externally by healthcare professionals prior to moving to the home, and by staff at the home.

We spoke with people who lived at The Gables Care Home about the culture of the home. The responses we received were positive.

We saw that some audits were carried out at the home. Examples seen were care plan audits and medication audits. However we found that other formal audits, such as for Infection Control and health and safety were done on a more informal basis.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

We spoke to three people who lived at the home and two relatives who visited on the day of our inspection regarding staffing levels and the competence of staff. One of the people living at the home told us, "There are usually enough staff around, perhaps at weekends numbers can on occasion be lower". Another person living at the home said, "There are enough staff here". One relative told us, "There are always at least three care staff on as well as the cook and the cleaner, the staff here are excellent. I haven't a bad word to say about any of them".

Since our last inspection in June 2013 it was evident that a number of improvements and updates had been made to the home. The external fire escape had been renovated and new external fire doors had been ordered to complete the work. New carpets had been installed downstairs, the living / dining room had been painted and several rooms had been redecorated, either as part of the ongoing maintenance plan or at the request of people living at the home. A new wet room had been put in place downstairs and windows replaced at the front of the home.

Is the service effective?

We looked at care plans for three people living at the home. People's needs were assessed and care and support was delivered in line with their individual needs. We saw that care assessments had been carried out and daily

monitoring records had been completed. Care plans were easy to follow and it was evident that regular reviews of people's needs were carried out. Risk assessments were in place covering areas such as moving and handling, falls and nutrition. Evidence was in place showing that monthly reviews of all risk assessments were carried out.

Is the service caring?

We spoke with two visiting District Nurses. They spoke very positively about the home. They told us, "This is one of the better homes we go into, the care people received seems excellent and residents' seem very happy and well looked after. Any advice we give is always listened to".

Is the service responsive?

The people we spoke to who lived at the home all felt comfortable making a complaint if they needed to. One person said, "I've never had any issues here. If I had a problem I'd go to (Name of registered manager) or any member of staff in fact". None of the relatives we spoke to had needed to raise any issues but all said they would have no issues doing so if required.

Staff we spoke to on the day of the inspection knew how to support people to make a complaint or who to direct them to do so.

Is the service well-led?

The home had a current Investors In People (IIP) gold standard external accreditation in place. IIP is a business improvement tool administered by UK Commission for Employment and Skills and supported by the Department for Business, Innovation and Skills. Only approximately 2% of organisations who have IIP accreditation achieve the gold standard.

People's needs were assessed and care and support was planned and delivered in line with their individual care needs. From speaking to staff it was clear that they were able to act appropriately in the event of an emergency such as a fire or a medical issue.

Staff told us they felt supported in their role and that they had the opportunity to develop their skills. They also told us that managers were approachable and listened to any concerns or ideas they had.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.

We observed that staff interaction with people was very good. Staff engaged with them in conversations. They spoke to them respectfully, communicated well and appropriately, and offered assistance when needed. It was evidenced that where possible independence was promoted. People requiring assistance to eat was given this with dignity and patience.

People told us they were given the help and support they needed. They said staff were 'Very good' and 'Helpful.

We observed people in the home were relaxed around staff. They were able to express themselves freely and openly. People who were able to express themselves told us staff treated them well and they had no cause for concern. There were no rules to follow and no rigid routines.

We observed how people engaged with staff in various activities of daily living. Staff was always present around people and available to offer assistance when needed.