Archived: The Gables

The Gables is a residential care home providing personal care to 43 people at the time of the inspection. The service supports younger adults, older people, people with physical disabilities and people living with dementia. The service can support up to 60 people.

The Gables accommodates people in one adapted building with five separate units, each of which has separate adapted facilities. The service has a central hub with a café, hairdressing salon and shop.

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

People were at risk due to a lack of consistent record keeping and oversight by the registered manager and provider. The provider’s quality assurance checks had not been sufficiently robust to identify issues we found on inspection. This included with assessments and care plans not always being in place. The provider gave assurances lessons would be learnt following the inspection. The registered manager showed us examples of the improvements they had started to make to records.

Despite the shortfalls we found with health and safety and risk record keeping, people and their relatives told us they felt safe at the service. Staff knew how to respond to any safeguarding concerns and acted immediately in response to any emergencies. Medicines were managed and administered when needed. Appropriate measures were in place to support infection prevention and control to keep people safe.

Care staff provided effective care; they were knowledgeable about people’s care needs and had the skills to support them. The provider did not always complete assessments or care plans to guide staff in delivering people’s care and ensure they received consistent care. We made a recommendation that the provider risk assesses the external environment at the service.

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 and their relatives consistently praised the caring approach by care staff, which made people feel at home at the service and part of The Gables family. Care staff made time to support people’s emotional wellbeing. People’s privacy and dignity were respected.

Care staff provided person-centred care, they knew people’s needs and preferences. People were able to join in with a wide range of activities, developed according to their needs and abilities. Relationships between people, their family and friends were supported via in-person visits, video calls and telephone calls. People had not felt the need to raise any complaints as they were able to discuss their care and any improvements needed to their care arrangements with care staff. We made a recommendation about end of life care planning.

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

Rating at last inspection

This service was registered with us on 01/05/2019 and this is the first full inspection.

Why we inspected

This was a planned inspection based on when the service was registered.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to person-centred care and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The provider had good procedures for preventing visitors from catching or spreading infection. The service was in recovery from a Covid-19 outbreak and, in line with guidance, all but essential visiting had been suspended. The provider had suitable policies and procedures in place to minimise risk during visits when they recommenced. End of life visits had taken place so that a family member could sit with their relative.

The home had an extra large 'tablet' that people used to Face time or Skype families and friends. Families could talk with staff by phone. Consultations with health care professionals could also be done virtually and the staff team told us the community nurses visited and were very supported to them and to people in the home.

The staff team had supported people to isolate during the outbreak of Covid-19 and people had understood the reasons for isolating. People had now recovered from the virus and no longer needed to isolate. Good arrangements were in place so that people kept a safe distance in shared areas. This is a new build home. People had large en suite bedrooms and spacious shared areas so they could keep a distance from each other. People living with dementia were guided and supported to do this as much as possible.

There had been no admissions to the home for some time. The provider and the registered manager were not looking to admit until people and staff had fully recovered both physically and emotionally from the recent outbreak. When they were ready to admit this would be after a negative test result and people would be supported to isolate in their rooms for the recommended period of time.

The staff and the people who lived in the home had been tested routinely. Those who had a negative test continued to be tested. Staff and service users had all received the Covid -19 vaccine. In some instances they had received a second vaccine.

The home was very clean and hygienic. The staff followed national and local guidance during the outbreak and rigorous systems were in place to ensure good levels of hygiene. There were cleaning schedules and other systems to ensure good infection prevention and control measures. Staff understood how to use and dispose of personal protective equipment.

We met with staff who were very positive about their work and told us the welfare of people in the home was very important to them. They acknowledged the trauma of dealing with an outbreak but said that they worked well as a team and could talk to management and to each other. Arrangements had been put in place to ensure the staff could return to work safely. There were plans for staff to access counselling if necessary. Good risk management was in place for service users and staff from ethnic minorities or who had underlying issues that would reduce their risk of serious illness.

The Gables is a residential care home providing personal care for up to 60 people who have needs associated with ageing or are living with a dementia related illness. At the time of the inspection 43 people were living at the home. The Gables is a brand new purpose-built care home with large communal areas and accessible gardens. There are four separate units, with smaller communal and kitchen areas and all bedrooms are ensuite.

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

People were very happy about the care and support they received and with the way the home was managed. People felt safe and were protected from harm. Staff understood how to protect people from abuse. Risk assessments were carried out to enable people to retain their independence.

The registered manager and staff were adhering to strict infection control practices and following national good practice guidance in relation to the COVID-19 pandemic. People, their relatives and the staff team felt very reassured by the measures in place.

There were enough numbers of staff to meet people's needs and ensure their safety. Extra staff had been made available to support people across the pandemic. The provider’s recruitment processes ensured new staff were suitable to work in the home. Staff were well trained and supported for their role. They felt valued and enjoyed working at the home.

Everyone was very satisfied with the service. The home was being well-led by the registered manager and senior team. People's views about the quality of care were used to make improvements. Lessons had been learned and shared with staff, people and their relatives when things went wrong.

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

Rating at last inspection

This service was registered with us on 01/05/2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the management of falls. The first inspection since registration had also been delayed due to the Covid-19 pandemic. A decision was made for us to now inspect and examine those risks. We focused on the two key questions of Safe and Well-led. Targeted inspections do not change or give a rating. This is because they do not assess all the key questions or cover all the areas within a key question.

We found no evidence during this inspection that people were at risk of harm from this concern.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Please see the Safe and Well-led sections of this full report.

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.