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Gabriel Court Limited Requires improvement

Reports


Inspection carried out on 28 July 2020

During an inspection looking at part of the service

About the service

Gabriel Court is a residential care home separated into two units providing personal care to up to 44 people. One unit is the lower dependency unit and the other is the higher dependency unit, where people with more advanced dementia are cared for. At the time of our inspection there were 38 people using the service.

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

Medicines were not always safely managed. As a result, three people had not received their medicines as prescribed and stock control systems required improvement.

The provider had quality control systems in place, however they were not always effective as records were not always correct and audits had not always identified errors in records.

There were enough skilled and experienced staff to meet people’s needs. Staff were adequately trained and had regular competency checks. Staff told us that they felt supported by the management team.

People’s individual risks were managed in a safe way and staff knew how to protect people from the risk of harm and abuse. Risk assessments were completed appropriately, for example around nutrition, pressure sores and mobility.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

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

The last rating for this service was inadequate (published 5 June 2020) and there were breaches of nine regulations. We placed conditions on the provider’s registration whereby they were required to send monthly reports on the improvements they had made. At this inspection improvements had been made, however the provider was still in breach of regulations so the conditions remain in place.

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, moving and handling practices and wound care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

The overall rating for the service has changed from inadequate 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 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 Gabriel Court Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to the management of medicines and the accuracy of records at this inspection. We also found that when the provider identified that improvements were needed, action plans were not always created to evidence that the required improvements were being addressed.

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

Follow up

We will contin

Inspection carried out on 28 January 2020

During a routine inspection

About the service

Gabriel Court Limited is a residential care home for up to 44 older people living with dementia. At the time of inspection there were 40 people living at the home.

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

There was a registered manager who had been the manager of the service since it registered with CQC in October 2010.

The provider failed to have adequate systems to assess, monitor and mitigate the risks to people’s health, safety and welfare. The provider had not kept up to date with current legislation to keep people safe.

The provider failed to have systems and processes to assess, monitor and improve people’s quality and safety of care. They failed to have quality monitoring of all areas to identify where people were not receiving care that met their needs.

The provider failed to have systems to safeguard people from abuse or improper treatment. People were not always treated with dignity and respect.

People, their relatives and representatives had not been involved in the planning of their care. People’s feedback and complaints had not been used as learning or used to improve the quality and safety of care.

There were not enough skilled and experienced staff to meet people’s needs. Staff were not adequately trained, and their competencies had not been checked. Staff did not receive the support and supervision they required to carry out their roles.

The provider failed to update peoples’ risk assessments and care plans regularly or as their needs changed. They failed to have a safe handover system to ensure staff had information about people’s current needs.

People did not always receive food and drinks in a safe way or that met their needs. People did not always receive care that had been recommended by health professionals or receive their medicines as prescribed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People had access to indoor and outdoor communal areas. Staff were recruited using safe recruitment practices. Staff understood when to seek medical advice.

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 26 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified nine breaches of regulation in relation to safety of the environment, safeguarding, staffing, nutrition, consent, respect, person centred-care, complaints and governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the

Inspection carried out on 1 August 2017

During a routine inspection

This inspection took place on the 1st August 2017 and was unannounced.

Gabriel Court provides accommodation and personal care for older people, including people living with dementia and who have physical and mental health needs. The service can accommodate up to 44 people. At the time of our inspection there were 43 people living at the home.

At the last inspection, in August 2015, the service was rated Good. At this inspection we found that the service remained Good.

People were treated with respect, kindness and empathy; they had developed positive relationships with the staff that were caring. People had detailed personalised care plans in place which enabled staff to provide consistent care and support in line with people’s personal preferences.

People continued to receive safe care. Staff were appropriately recruited and there were sufficient staff to meet people’s needs. People were protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision, training and on-going professional development that they required to work effectively in their roles. People were supported to maintain good health and nutrition.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. There were a variety of activities available for people to participate in if they wished to.

The service had a positive ethos and an open culture. The registered manager and provider were committed to develop the service and actively looked at ways to improve the service. There were effective quality assurance systems and audits in place; action was taken to address any shortfalls.

People knew how to raise a concern or make a complaint and the registered manager had implemented effective systems to manage any complaints that they may receive.

Inspection carried out on 29 May and 4 June 2015

During a routine inspection

This unannounced inspection took place on the 29 May and 4 June 2015.

Gabriel Court accommodates and provides care for up to 44 older people, most of whom have dementia care needs. There were 39 people in residence during this inspection, with two people in hospital.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 cared for by sufficient numbers of staff were experienced and trained to meet their needs. Recruitment procedures were robust and protected people from receiving care from staff unsuited to the job.

People received care from efficient staff that understood their role and knew what was expected of them when caring for older people. Staff were attentive, friendly and enabled people to do things for themselves by providing people with the individualised care that suited their needs.

People’s care needs had been assessed and they each had an appropriate care plan. Their care plans were regularly reviewed and were individualised to reflect their current needs so that staff had the necessary information and guidance to meet these needs. People benefited from receiving care from staff that listened to and acted upon what they said, including the views of their relatives, friends, or significant others.

People’s health and wellbeing needs were met by staff that were supported by community based healthcare professionals as and when required. The advice of healthcare professionals was acted upon by staff and people’s prescribed treatments were provided in a timely way.

People’s individual nutritional needs were assessed, monitored and met. People who needed support with eating and drinking received the help they required. People enjoyed their food, had enough to eat and drink, and the choice of foods available took into account people’s tastes, preferences and cultural backgrounds. They enjoyed a varied and balanced diet to meet their nutritional needs.

People’s medicines were appropriately and safely managed. Medicines were securely stored and there were suitable arrangements in place for their timely administration.

People were assured that if they were dissatisfied with the quality of the service they would be listened to and that appropriate remedial action would be taken to try to resolve matters to their satisfaction. People knew how and who to complain to.

People received care from staff that were supported and encouraged by the provider and the registered manager to do a good job caring for older people. The service provided was effectively quality assured by the audits regularly conducted by the registered manager and the provider.

Inspection carried out on 15 October 2013

During an inspection looking at part of the service

During this inspection on 15 October 2013 we spoke with the owner, a cleaning staff and two care staff. We did not speak to any people that used the service.

Care staff we spoke with told us that they had undertaken a thorough cleaning of the home since our last inspection. The cleaner told us, ��We now have a revised programme that makes sure the home gets a thorough clean at least once every month.��

The owner told us that the home had its own deep cleaning equipment and had a dedicated person to operate this equipment.

The provider had taken adequate steps to ensure the home was clean and we found all areas of the home clean.

When we visited the provider told us that they did not carry out diagnostic and screening procedures or treatment of disease, disorder or injury. We have advised the provider to have these regulated activities removed if there is no intention to provide these.

Inspection carried out on 29 July 2013

During a routine inspection

During our inspection we spoke with five people who used the service, four visitors and three members of care staff. We found that people had received care that was appropriate to their personal needs. A person who used the service said, ��All my needs are taken care of. They help me with everything. A visitor told us, ��My relative is looked after well. I like the care staff very much because they are very caring and attentive.��

A health care professional who visited the home regularly said, ��We work very closely with the care team here and they are attentive towards people�s needs and work with us closely in maintaining their health needs.��

People's care plans were detailed and took account of their individual needs. We found that the provider had made the improvements we asked them to make at our last inspection on 14 December 2012 and had made sure that the immediate needs of people who came to live at the home more recently had been assessed and met in a timely way.

We found that the provider needed to make improvements to the way the home was cleaned and maintained.

The provider had adequate quality assurance systems to ensure the safety and comfort of people who lived at the home.

When we visited the provider told us that they did not carry out diagnostic and screening procedures or treatment of disease, disorder or injury. We have advised the provider to have these regulated activities removed if there is no intention to provide these.

Inspection carried out on 13, 14 December 2012

During a routine inspection

We found that people were encouraged to express their views and make choices. A person who used the service said, ��I like to spend time in my room and they respect that.�� A relative we spoke with said, ��It feels like you are in your own home rather than in a care home because they are so caring.��

People�s care plans were detailed and took account of people�s individual needs and how this would be supported. However we found that the provider needed to make improvements to ensure that the immediate needs of people who came to live at the home more recently were assessed and met in a timely way.

We found that the provider took adequate steps to protect the people they cared for and their carers from harm. The provider had adequate quality assurance systems which made sure the safety and comfort of the people they cared for were maintained and any problems quickly resolved.

Inspection carried out on 23 December 2011

During a routine inspection

Residents and relatives were very positive about the care and support provided at Gabriel Court. Their comments included:

�Staff treat me with respect�, �I go out when I want to, staff just ask me to tell them when I am going out.� �I always have someone to chat to�.

�I get all the help I need�, �I have to have a special diet and staff make sure that I have what I need�. �I know my mum is well looked after�.

Residents told us that they felt safe and one commented: �I feel safe here, if there is a problem it is always dealt with�.

Reports under our old system of regulation (including those from before CQC was created)