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Gable Lodge Requires improvement

Reports


Inspection carried out on 16 August 2019

During a routine inspection

About the service

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.

Inspection carried out on 9 January 2017

During a routine inspection

Gables Lodge is a small care home which can provide personal care and accommodation for up to nine adults. The service specialises in supporting older people living with dementia. At the time of our inspection there were seven people residing at the home.

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.

Inspection carried out on 27/04/2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 27 April 2015. When we last visited the home on the 14 November 2014 we found the service was breaching regulations in relation to care and welfare and consent. This was because the service had not taken the necessary action to ensure adequate care planning was in place for people who were at risk of choking. In addition, the service was not meeting the requirements in relation to Deprivation of Liberty Safeguards (DoLS). The registered manager had not made applications to deprive people of their liberty safely as required by law. We also found the premises were not always safe. In addition, systems to monitor the quality of service were not effective as they had not identified the issues we found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements and have addressed all areas where improvement was required. We found the provider had taken all the necessary action to improve the service in respect of the breaches and issues we found.

This report only covers our findings in relation to those requirements. 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

Gable Lodge is a care home for up to nine older people. At the time of our visit there were five people living at the home, many of whom were living with the experience of dementia.

The home had 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.

People were protected from the risks of choking as the manager had ensured people at risk were assessed by speech and language therapists (SALTs). Guidance from SALTs was incorporated into people’s care plans to ensure their care was planned safely. Staff had a good knowledge of this guidance and followed this guidance when supporting people to eat and drink. The registered manager had also trained staff to understand better the appropriate action to take in a choking emergency.

The registered manager had taken action to make the premises safe. They had installed an alarm system on doors so that staff were alerted if people who required staff support in the community left the home through a fire door. In addition, the registered manager had taken appropriate steps to control the risks of people acquiring Legionella infections.

The provider was meeting their requirements in relation to Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

Quality assurance systems had been strengthened to incorporate systems to regularly check on the issues we identified at our previous inspection.

Inspection carried out on 14/11/14

During a routine inspection

This inspection took place on 14 November 2014 and was unannounced. When we last visited the home on the 4 October 2013 we found the service was meeting all the regulations we looked at.

Gable Lodge is a care home for up to nine older people. At the time of our visit there were seven people living at the home, many of whom were living with the experience of dementia.

The home had 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.

People were not always protected from the risks of choking as the manager had not ensured that people who were at risk of choking had been adequately assessed, and that guidelines in place were adequate. Not all staff had the necessary knowledge to provide people with suitable first aid in the event of people choking. You can see what action we told the provider to take at the end of this report.

The premises were not always safe. Risks in a number of areas were not identified so plans could be developed to minimise risks to people.

The provider was not meeting the requirements in relation to Deprivation of Liberty Safeguards (DoLS). DoLS provide legal safeguards for people who may have restrictions placed on them as part of their care plan. The manager had identified that two people required authorisation to deprive them of their liberty but had not made the applications within a reasonable time period. However, staff had understood the importance of obtaining consent from people before they provided care and support. You can see what action we told the provider to take at the end of this report.

People enjoyed the food and were provided with a variety of food to choose from. Staff monitored people’s weight and referred them on for specialist support, when they were concerned about their risk of malnutrition.

Staff understood people’s health needs and people had access to health professionals according to their needs. Care plans and risk assessments were in place regarding a range of different needs. Medicines management was safe.

People using the service and their relatives described the manager and staff as being warm and caring, and were happy with the care and support they received. We saw that care was delivered with kindness, dignity and respect. People had good relationships with staff and received care and support to meet their individual needs. Staff had a good knowledge of people’s backgrounds and preferences which meant they knew how people would like their care delivered. People were supported to spend their time as they pleased.

The manager involved people and their relatives in their care and sought people’s views and suggestions via meetings, surveys and regular informal contact. The service had an accessible complaints procedure which people and their relatives were aware of. Relatives told us they had never had cause to complain.

Staff had clear lines of responsibility and the manager, who was also the owner, directly oversaw all aspects of the service. A range of audits were in place to monitor the right standards in different aspects of the service.

Inspection carried out on 4 October 2013

During an inspection looking at part of the service

We reviewed three care files and found that people's needs were assessed before care was delivered and that their needs were regularly reviewed. Previously, we were concerned that there was no information available for people or their relatives to enable them to make decisions about their end of life care. During this inspection we found that people were involved in the assessment and planning for their end of life care.

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.

Inspection carried out on 5, 11 July 2013

During a routine inspection

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Staff we spoke with were aware of their obligation to obtain people's consent. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

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.

Inspection carried out on 19 October 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

We used the Short Observational Framework for Inspections (SOFI). SOFI is a specific

way of observing care to help us understand the experience of people who could not talk with us.

People we spoke with told us they were happy living at Gables Lodge and that the staff who worked there were kind and caring. One person we spoke with said �I feel safe and comfortable living here" and another person told us �I am very happy living in this home. I feel safer here than I would at my own home�.

We saw staff provided care and support in a way that protected the rights and dignity of people using the service.

Inspection carried out on 8 March 2011

During a routine inspection

We spoke to one person who uses the service, a member of staff, the deputy manager and two relatives who were visiting their parents at the home.

The person who uses the service told us, �my privacy and dignity is respected and staff always ask me if there is anything I want or need, there are meetings with the manager, staff and other people who use the service and their relatives to talk about what�s happening about the home, I have no complaints about the food, staff ask me what I want and I get it, its always nice".

They also told us, "I am very content here, I have a comfortable room and I can just shut the door and read my books or do what I like at night. I can talk to staff or the registered provider if I have any concerns and I am sure they would do something about them, you don�t have to worry about me the staff look after me very well".

A relative told us �it was an extremely difficult decision to place my parent in a care home, I looked at a number of others but when I visited Gable Lodge I knew right away this was the right place for my parent, the place is spotlessly clean and it feels like a very safe environment and the registered provider and the staff provide excellent care, I had reservations about moving my parent into a shared room, however they spend most of the time out of the bedroom and only sleep there at night, having a single room doesn�t mean the care would be better in fact the quality of care that they receive from the staff more than compensates for not having a single room".

They also told us, "the food here is freshly cooked everyday, people have really good dinners and cereals or fried breakfasts, sometimes when I come on a Sunday they give me a roast dinner. When my parent went into hospital recently the registered provider visited them everyday and brought them freshly cooked meals from the home, this was very greatly appreciated by my parent and the rest of my family, the registered provider and all of the staff are really caring".

Another relative told us, "I visit once a week and the home is always beautifully clean, the registered provider and staff make me feel very welcome, when I leave the home I feel content because I know that the care is very good and my parent is well looked after�.

We spoke to a member of staff and the deputy manager.

The member of staff has worked at the home for twenty two years, they told us, "I receive regular supervision and an annual appraisal, I attend regular monthly team meetings and receive lots of training, the registered provider is very caring of the people who use the service and the staff, I really like working at this home".

The deputy manager told us, "I receive regular supervision and support from the registered provider and I supervise some of the staff, I�ve been here eighteen months, it�s a good place to work�.