Gable Lodge

Gable Lodge is a residential care home providing personal care to up to 9 people. At the time of our inspection five older people, some of whom were living with dementia, were using the service. Gable Lodge does not provide nursing care.

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

Whilst improvements had been made to fire safety procedures we found that a safe environment was not always provided and people had not been appropriately protected from the risk of injury from falling from height due to windows not being appropriately restricted. Nevertheless, a homely environment was available and people were able to personalise their rooms. Work had been completed on bathrooms and accessible wet rooms.

There were safe staffing levels and staff received regular training and supervision to ensure they had the knowledge and skills to undertake their role.

Staff were knowledgeable about the people they supported. 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. Staff provided people with support related to their personal care, their nutritional needs and health care. Staff were aware of the risks to people’s safety and how to support people to mitigate those risks. People received their medicines as prescribed. Staff worked with other health and social care professionals to ensure people received coordinated care.

However, we found that care records were not sufficiently detailed meaning there was a risk that people may not get appropriate care if being supported by new staff or agency staff.

There were systems in place to review governance systems however, they had not picked up the improvements required found at inspection. People, their relatives and staff were asked for their feedback about the service and these were used to improve practices. The registered manager attended provider forums and webinars to learn about best practice guidance.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 May 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 17 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance arrangements and the delivery of safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm whether they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

Enforcement and Recommendations

We have identified continued breaches in relation to safe care and treatment 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Gable Lodge is a residential care home providing personal care and accommodation to people aged 65 and over. At the time of the inspection six people were living at the service.

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

Since our last inspection we found the service had made improvements around the storage of medicines and risk assessments for people. However, some essential work concerning fire safety still needed to be completed and this meant people may not be safe in the event of a fire. Some fire safety checks were not up to date.

Records confirmed people received the right amount of medicines at the right time but did not always explain how people liked to take their medicine's. Staff had received training so they could give medicine's to people safely and the registered manager checked this was happening, but these checks were not written down. We have made a recommendation to the provider to review best practice guidance in this area.

Systems remained in place to protect people from abuse and staff had been trained in safeguarding adults. There were enough staff working at the service to meet people's needs and checks were carried out with new staff to make sure they were suitable to work in a care setting.

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. However, the registered manager did not always record meetings with people, healthcare professionals and family members when decisions were made about people’s care and support needs.

Work improving the environment for people was in progress and the registered manager had a clear plan for completion. This work will make it easier for people to use the bathing facilities and to access the garden.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 October 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found some improvements had been made, however, the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about infection control and health and safety issues concerning the environment. We also worked with the local authority following concerns raised about one person’s care and support. A decision was made for us to inspect and examine those risks. Although we found no evidence during this inspection that people were at risk of harm from these concerns there were still areas that needed to be improved to make sure people were safe.

We undertook a focused inspection to review the key questions of safe and well-led and we took a targeted approach in effective. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan from 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.

Gable Lodge is a residential care home providing personal and accommodation to six people aged 65 and over at the time of the inspection. The service can support up to nine people.

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

We found the service was not always safe or well-led. This was because medicines were not stored securely, people received care that had not been properly assessed for risk and quality assurance systems were not always effective. We also found that bathing and toilet facilities at the service were in need of review and we have made a recommendation about this.

Systems were in place to protect people from abuse and staff had been trained in safeguarding adults. There were enough staff working at the service to meet people’s needs. Checks were carried out on new staff to verify their suitability to work in a care setting. Steps had been taken to reduce the risk of the spread of infection.

Assessments were carried out to assess people’s needs and to determine if the service could meet those needs before they moved in to the service. People were able to choose what they ate and drank and were supported to eat a nutritious diet. People had access to health care professionals. People were supported to have maximum choice and control of their lives. However, staff did not always support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were sometimes restrained without proper risk assessments in place about this.

People told us staff treated them well. Staff understood how to support people in a caring and respectful way. The service sought to meet people’s needs in relation to equality and diversity. People's right to confidentiality was promoted.

Care plans were in place. These set out people’s needs in a personalised manner. Plans were subject to review which meant they were able to reflect people’s needs as they changed over time. Some activities were provided, although there was room for improvement in this area, and we have made a recommendation about this. The service had systems in place for responding to complaints.

Staff spoke positively about the registered manager and there were clear lines of accountability in the staff team. People’s views were sought on the running of the service and staff had the opportunity to raise any issues or concerns they had.

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 good, (published 2 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to the secure storage of medicines, the use of physical restraint and ineffective quality assurance and monitoring systems at this inspection.

Please see the action we have told the provider to take at the end of this 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.

At the last Care Quality Commission (CQC) inspection in April 2015, the overall rating for this service was Good. At this inspection we found the service remained Good. The service demonstrated they continued to meet the regulations and fundamental standards.

People continued to be safe at Gable Lodge. There were robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse. The provider assessed and managed risks to people’s safety in a way that considered their individual needs. There were enough staff to keep people safe and recruitment procedures were designed to prevent people from being cared for by unsuitable staff. The premises and equipment were safe for people to use because staff routinely carried out health and safety checks. Medicines were managed safely and people received them as prescribed.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs. They also received the support they needed to stay healthy and to access healthcare services.

Staff were caring and treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People received personalised support that was responsive to their individual needs. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. This meant people were supported by staff who knew them well and understood their needs, preferences and interests. Staff encouraged people to actively participate in leisure activities, pursue their social interests and to maintain relationships with people that mattered to them.

The registered manager continued to provide good leadership and led by example. The service had an open and transparent culture. People felt comfortable raising any issues they might have about the home with staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider also routinely gathered feedback from people living in the home, their relatives and staff. This feedback alongside the provider’s own audits and quality checks was used to continually assess, monitor and improve the quality of the service they provided.

Further information is in the detailed findings below.

At our last inspection we found that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. During this inspection we saw that comprehensive, personalised risk assessments were carried out which considered a variety of risks and gave detailed information on how the risks identified should be managed.

We found that people's care and treatment was delivered in accordance with their care plan. People using the service were satisfied with the way their care and treatment was delivered. One person told us "it's good here." Another person told us, "I'm well looked after."

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We spoke to people's relatives and their comments about the service were positive. One person told us 'the staff are brilliant, very caring. We are welcome at any time, it feels like a family home.' Another relative told us, 'I have nothing but praise for the manager and staff.' However we found that people's care was not always planned and delivered to meet their individual needs or to ensure their welfare and safety. We were concerned that the risk assessments we looked at had not been reviewed in the last twelve months. There were no plans in place to minimise the risk to people in the event of an emergency.

We found that people who use the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The service did not have an up to date safeguarding policy and staff did not have good knowledge about safeguarding vulnerable people from abuse.

We found that staff were supported by the management and the provider had an effective system to regularly assess and monitor the quality of service that people receive.