Archived: The Gable

At the time of our inspection, we were informed the ownership of the home had change. Appropriate applications had been forwarded to CQC for consideration.This meant new systems and records were being introduced at the time of our inspection.

The Gable is a large end terrace in a residential area close to Burnley town centre. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

At the last inspection on 16 and17 November, the overall rating of the service was 'requires improvement' and our findings demonstrated there were three breaches of the regulations in respect of unsafe management of medication, failing to ensure risks to people's wellbeing and safety were assessed and managed and a lack of compliance with the Mental Capacity Act 2005. The service was rated "Requires Improvement." Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service.

At this inspection we found the provider was in breach of five regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. They related to the provider having insufficient risk assessments, unsafe processes for the management of medication, a lack of appropriate training for new staff, lack of oversight of the service and a lack of compliance with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection, the service was rated as overall 'requires improvement,' at this inspection the rating had remained as 'requires improvement.'

We were aware the proposed new provider was committed to an extensive programme of development which would improve people's lives. This included changes to the environment, policies and procedures and to the records and systems. During this inspection, we found changes were in progress.

We found there were management and leadership arrangements in place to support the day to day running of the home. However, the provider needed to ensure better oversight of the service to ensure they were meeting the regulations and that the service was effectively managed.

There had been improvements to the management of medication since our last inspection and an updated medication policy, including "covert medication" guidance was due to be issued by the new provider.

We found that people's concerns and complaints were not always acted upon and risks around individuals were not fully assessed and managed safely. A safeguarding alert was raised during the inspection, due to concerns raised by a person living at the home.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff respected people's diversity and promoted people's right to be free from discrimination. However, we found that there was still some confusion around the processes around the MCA 2005 and the necessary improvements had not taken place. The provider agreed to implement capacity assessments and seek further training and guidance in this area.

We found that the provider was unaware that bank staff were required to have the same training as permanent staff. We found one new staff member was new to care and had not had access to appropriate training.

We found that arrangements on entering the home were not as secure as they could be, however this was addressed immediately during the inspection. We felt that the home required updating and we were advised that a significant refurbishment was due to take place. People at the home were excited at the proposed changes taking place.

People and their relatives told us that they were happy living at The Gable. People told us if they had a complaint, they knew how to raise their concerns. There was an easy read complaints policy in place and we saw evidence that people were able to raise issues. We did note that further work was required in this area, as not all complaints were properly actioned.

People's privacy, individuality and dignity was respected and we observed staff interacting positively with people throughout the inspection.

Each person had a care plan, describing their individual needs and choices, which provided guidance for staff on how to provide people with support. Care and support was kept under review and some people had person centred care plans in place. People's healthcare needs were well met and referrals had been made to other health professionals. However, this was not always consistent and we found important information and updates on medication and medical diagnoses had not been updated and reflected in the plans. The storage of records, also required improvement to ensure they were stored securely.

People were supported with a range of activities that met their needs and preferences and had opportunities to maintain and develop their skills both inside the house and in the local community. People told us that they were consulted about changes in the home and they were involved in menu planning, food shopping, housework and meal preparation.

We saw evidence of the service actively consulting with people and their relatives around changes within the home. People's views were obtained and people generally felt their views and choices were listened to. We saw a range of feedback questionnaire's consulting with people who used the service, their relatives, staff and wider community groups that supported the people in their local community.

The Gable is a care home which is registered to provide care and accommodation for up to six adults with a learning disability and does not provide nursing care. People in care homes receive accommodation and 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. The Gable is an adapted building in a residential area in Burnley. At the time of the inspection there were six people accommodated at the service.

At the time of the inspection, the service was without a registered manager. 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. There was a manager in post who had commenced the initial process for registration, but had not yet submitted an application with the Commission.

At our last inspection on 5 January 2015 the overall rating of the service was ‘Good’ and there were no breaches of the regulations. At this inspection we found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. They related to the provider having unsafe processes for the management of medicines, insufficient risk assessments and risk management processes and a lack of compliance with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.

We found there were management and leadership arrangements in place to support the day to day running of the service. However the providers need to have better oversight of the service and improved checking systems, to make sure the service is safely and effectively run.

Systems were in place to maintain a safe environment for people who used the service and others. However we found some matters were in need of attention.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. There were enough staff available to provide care and support and we were told staffing arrangements were kept under review.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on safeguarding and protection matters.

We found people were supported to make their own decisions and choices. They were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were satisfied with the meals provided at The Gable. Arrangements were in place to offer a balanced diet. People were actively involved with devising menus, which meant they could make choices on the meals provided.

People made positive comments about the care and support they received from staff. We observed positive and respectful interactions between people using the service and staff.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities and preferences before they used the service.

Each person had a care plan, describing their individual needs and choices. This provided guidance for staff on how to provide support. People had been involved with planning and reviewing their care. People’s privacy, individuality and dignity was respected.

People were supported with their hobbies and interests, including activities in the local community and to keep in touch with their relatives and friends. Their well-being was monitored and reviews of their needs were held.

There were processes in place for dealing with complaints. There was a formal procedure to manage, investigate and respond to people’s complaints and concerns. People could also express concerns or dissatisfaction during their care reviews and during residents meetings.

There were systems in place to consult with people who used the service and staff, to assess and monitor the quality of their experiences.

Comments included, "I like the food; I can choose what I want and we go shopping with a list that includes all our requests".

Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found that the care plans were accompanied by risk assessments and risk management plans to ensure people were protected from unsafe care practices.

People we spoke with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from inappropriate staff.

People were provided with care plans that are regularly reviewed so that people have the most appropriate support to meet their needs and if these needs change, the support they receive is amended to reflect those needs.

People said they felt safe living in the home and were able to discuss concerns or issues with the staff if they wished to. We saw that the people using the service are involved in planning their care and are in control of how their support is provided for them. Risk assessments are reviewed regularly in respect of the person's needs, the environment and behaviour so that service users and staff are safeguarded.

We saw that there was access to a number of external activities and people were able to regularly access the local community.

We looked around the location and found that there has been an ongoing programme of refurbishment and decoration to improve the fabric of the home.