Archived: The Gables Residential Home

At our last inspection on 28 February and 2 March 2017 we found two breaches of legal requirements. We took enforcement action and placed a condition on their registration. The Registered Provider must not admit any service users to the location The Gables Residential Home, without the prior written agreement of the Care Quality Commission. The term "admit" includes re-admit and this restriction should be understood to include any person who has been resident at the home at any time. The service was also placed into special measures. Following the inspection the provider was required to submit an action plan to say what they would do to meet legal requirements in relation to the breach in Good Governance and Safe care and treatment. We also requested additional information from the provider about their service. The provider failed to provide us with the information we requested.

At this inspection we found that the provider had made some of the required improvements. However, we continued to find the service was not meeting the regulations and further improvements were required. There continued to be breaches of the regulations we inspected against and safe and well led domain remained inadequate. Therefore the service remains in special measures.

The Gables Residential Home provides accommodation for people who require personal care for up to 10 people and personal care for people living in their own homes. At the time of the inspection seven people were living in the residential home and eight people were receiving care in their own home. However, one person was in hospital on the day of the inspection meaning there were only six people who were currently using the service. The home is located on two floors with a stair lift to access both floors. The home had a communal lounge and dining room. Most people who received care in their own homes lived in flats that were on the same grounds as the residential home. The same staff group worked between both the residential home and flats.

The service had a registered manager who was registered to manager both accommodation for people and personal care. 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 protected from risks relating to their health and safety. Some assessments had been carried out but had not been reviewed when people’s needs had changed. Assessments to determine what support people needed had not been carried out since our last inspection placing people at risk of harm.

Staff could identify the potential signs of abuse and knew how to report any concerns. Where incidents had occurred that may cause concern these had not always been investigated to determine the cause. Measures had not been put in place to protect people from the likelihood of reoccurrence.

There were not enough staff deployed to keep people safe. Staffing levels had been assessed based on incorrect information. People did not have their needs assessed and it was not known how many staff were needed to meet their needs safely.

People living in the flats did not receive their medicines in a safe way or as prescribed by their GP. Medicine records had not been completed correctly.

Staff had not been recruited appropriately. Pre-employment checks had not been carried out before staff started to work at the service placing people at risk from unsuitable staff.

Equipment that people used had been checked to make sure that it was safe to use.

The provider had implemented systems and processes to monitor and improve the quality of the service that had been provided. However, these did not identify concerns that we found during this inspection.

The provider was receiving support from the local authority; however, they continued to fail by not implementing the changes being requested of them. They had not taken action following feedback from professionals to improve the delivery of the service that had been provided.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This could lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

We carried out an unannounced focussed inspection of this service on 13 September 2016. Continued breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to a breach of Regulation 18 Staffing.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements.

The Gables Residential Home provides accommodation for people who require personal care for up to 10 people and personal care for people living in their own homes. At the time of the inspection six people were living in the residential home and eight people were receiving care in their own home. The home is located on two floors with a stair lift to access both floors. The home had a communal lounge and dining room. Most people who received care in their own homes lived in flats that were on the same grounds of the residential home.

The service had a registered manager who was registered to manager both accommodation for people and personal care. 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 we carried out on 13 September 2016 we found that the provider had not met the regulations relating to staffing. At this inspection we found the provider had made some of the required improvements.

People were not consistently protected from risks relating to their health and safety. Risk assessments had sometimes been carried out but had not been reviewed or completed when people’s needs had changed. Control measures to protect people from risks in the environment had not been put in place. Where people had allergies this had not been recorded consistently to keep them safe.

Staff could identify the potential signs of abuse and knew how to report any concerns. Where accidents and incidents had occurred that may cause concern these had been recorded. However details of actions that had been taken were not always recorded.

People sometimes had to wait for their needs to be met. Staffing levels had been increased since our last visit and there were less people using the service. Staffing levels had not been reviewed to reflect the needs of people using the service.

People did not always receive their medicines safely. Medicine records had not been completed correctly.

Equipment that people used had been checked to make sure that it was safe. However, when it required maintenance this had not always been recorded as being completed in a timely manner.

Staff had not always been recruited safely. Pre-employment checks had not been thoroughly carried out before staff started to work at the service.

Staff received support through an induction to the service and supervision. There was an on-going training programme to provide and update staff on safe ways of working. We found that staff had not been trained fully to meet the needs of people who used the service. Training records showed that staff had not updated their training to make sure that their knowledge was based on current guidance and best practice.

People were supported to access healthcare services. Where people received support in their own homes, referrals to health professionals for assessments were not always made as soon as they were needed. Where people’s food intake needed to be monitored to reduce the risk of malnutrition the amount of food people had been given was not recorded.

People were asked to make choices about their care and staff asked people for consent before carrying out personal care.

People told us that staff were kind. Staff members knew people well and were able to tell us about their likes and dislikes. Staff respected people’s privacy while they were receiving care. However, the provider did not always respect people's dignity in relation to their personal clothing. People had not always been asked for their opinion on things that were happening in their home.

People took part in some activities to stimulate them. Relatives and friends were able to visit when they wanted to.

People had not been involved in reviews of their care plans to make sure information about them was current. The provider did not always make changes to the service that people received when their needs changed.

The provider had implemented systems and processes to monitor and improve the quality of the service that had been provided. These did not identify concerns that we found during this visit.

The provider had not implemented feedback from relevant person's that had been sought to improve the delivery of the service that had been provided.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary,another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 10 December 2015. Breaches of legal requirements were found. The provider sent us an action plan on 23 March 2016 telling us what actions they were taking to improve. At this inspection we found some areas of improvement. However further improvements were needed.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. 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 The Gables Residential Home on our website at www.cqc.org.uk.

At the last inspection carried out on 10 December 2015 we found the provider had not met the regulations relating to the safe care and treatment of people who used the service, good governance, staffing and ensuring fit and proper persons were employed. At this inspection we found the provider had made most of the required improvements.

The Gables Residential Home provides a care home service for up to 10 people and personal care for people living in their own homes. At the time of the inspection nine people were living in the residential home and 10 people were receiving care in their own home. The home is located on two floors with a stair lift to access both floors. The home had a communal lounge and dining room where people could relax. Most people who received care in their own homes lived in flats that were on the same grounds as the residential home.

The service had a registered manager who was registered to manager both accommodation for people and personal care. 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.

We found that there were not enough staff available to meet the needs of the people who used the service. Leicestershire County Council, who funds some of the people who live at the service, also found this. Following a visit by staff from the Council additional staff were put on duty to improve staffing numbers.

We found that audits were completed. These had identified some areas for improvement and we saw that this work had been completed. However, we found that not all environmental concerns had been identified, recorded or addressed.

People were protected from risks relating to hot radiators and hot water. Radiator covers were put in place or repaired and checks were carried out on the temperature of the water. Risks associated with people's care were assessed and managed to protect people from harm.

People received their medicines as required and these were administered safely.

There were recruitment procedures in place that were usually followed. We found that one staff member had started work before all recruitment checks had been completed. The registered manager told us that the staff member did not work alone during this time. Information about previous employment history had been recorded. This is important to make sure that all of a staff member's work history had been recorded and there were no gaps.

We found that systems were in place and were used to monitor the health and safety of the service being provided. Records showed that checks were completed on a scheduled basis.

The service was led by a registered manager who understood their responsibilities under the Care Quality Commission (Registration) Regulations 2009.

We found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The Gables Residential Home provides accommodation for people who require personal care for up to 10 people and personal care for people living in their own homes. At the time of the inspection eight people were living in the residential home and nine people were receiving care in their own homes. The home is located on two floors with a stair lift to access both floors. The home had a communal lounge and dining room where people could relax. Most people who received care in their own homes lived in flats that were on the same grounds as the residential home.

The service had a registered manager who was registered to manage both accommodation for people and personal care. 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 told us that they felt safe. Most people told us that they liked living at The Gables Residential Home and they liked receiving support in their own homes. Staff knew how to identify and report abuse.

People living in The Gables were not protected from the risks of potentially dangerously hot radiators. The registered manager told us that environmental audits had been carried out but these had not identified the risk of the hot radiators. Radiator covers were in place but were broken and did not provide the protection they were meant to.

The provider did not have robust recruitment procedures in place. Pre-employment checks had not always been completed, and information about staff’s previous employment history had not been fully recorded.

People told us that there were not enough staff available and that they were kept waiting. There were not enough staff to meet the needs of people using the service.

Medicines were not stored correctly, some creams were not dated when they were opened and were not recorded as being administered. This meant that there was a risk that people were not receiving all of their creams and that they may have been open for longer than the recommended timeframe and not effective.

Staff were supported through training to be able to meet the care needs of the people they supported. We found that training records were not updated, not all training was in date and supervisions were not taking place regularly.

Staff told us that they sought people’s consent prior to providing their care. We saw that people’s capacity had been considered in their care plan.

People who lived at The Gables told us that staff were busy and did not always have time to respond to them. We saw that staff were completing a number of different roles and were supporting people in the care home as well as people who received care in their own home.

People received care and support that was centred on their individual needs. Their care plans included information about how they wanted to be supported.

Staff knew people well and understood their care needs. Staff treated people with dignity and respect.

People had not always had assessments completed that identified what support they needed and when they needed this. People who received support in their own home were receiving support at times then they wanted but this meant that people who lived at The Gables were sometimes waiting for support.

We found that quality assurance systems were not effective and audits had not been completed. The provider had not identified the shortfalls in quality that we found during this inspection. This meant that the provider was not able to ensure the people were receiving safe, effective, or responsive services that met their needs.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We saw that staff treated people as individuals and helped them with their specific needs in a friendly and supportive way.

We saw that there were adequate systems in place to monitor the quality of care that people received.

One person told us "There is high quality care here". Two people agreed "we get looked after well". Staff use care plans to guide care and give individualised care, specific to the person. People had the opportunity to partake in different activities, some of them in The Gables and some in the local community. People were visiting a 'Singing for memories' session on the day we visited.

Appropriate arrangements were in place in relation to obtaining medicine, keeping medicines safely and disposing of medicines appropriately. Medicines were all in date and were clearly labelled for individual people. Medicine records were completed fully.

There were suitable arrangements in place to ensure that staff were adequately trained, appraised and are developed. People felt that staff were trained well and experienced enough to care for them. One person said 'They know what they are doing and are good at it. The manager is very good'.

The Gables has a complaints system in place. People are listened to and complaints and comments acted on appropriately and effectively.