Archived: The Gables Care Home

The Gables Care Home provides support for up to twenty three people, including those living with dementia. On the day we visited there were twenty people living there. The home is situated in Buxton and in large building with big rooms and high ceilings. There is a garden for people who live in the home to use.

There was a registered manager in post at the home, who is also the provider of the home. 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 and associated Regulations about how the service is run.

Risks to individuals were not always assessed or acted upon. However, people were protected from bullying and harassment by a staff team who understood what to do if they had any concerns. People’s medicines were managed in a way that kept them safe. There were sufficient staff to keep people safe and recruitment of staff was done in a safe way.

Staff had the knowledge and skills to undertake their caring responsibilities and people were supported to have sufficient to eat and drink. However, the storage of food did not always meet standards to ensure people were given food which was safe to eat and drink.

People were supported to maintain good health and appropriate health care referrals were made. Consent to care and treatment was undertaken in line with the Mental Capacity Act and Deprivation of Liberty Safeguards.

People did not receive care that was personal to them and people’s preferences and wishes were not sought nor met. People knew how to make complaints.

There was not a person centred culture in the home which was open and empowering. Staff were supported by supervisions but did not feel supported by the registered manager. There were not sufficient systems and processes in place to ensure high quality care was delivered to people.

At this inspection 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.

Was it safe?

People's care records showed that staff responsible for determining people's consent to their care, were following the Mental Capacity Act 2005. They showed the types of decisions people were able to make or any advanced decisions they had made about their care and treatment. Where people lacked capacity and decisions needed to be made in their best interests, the provider acted in accordance with legal requirements.

People's care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare and their health needs were properly accounted for. We saw that staff supported people safely and in a way that met their needs and preferences. This included their mobility, medicines and their meals. One person told us, 'I am happy, I feel safe here; Staff are good and they look after me.'

Staff knew how to report abuse and any concerns about people's safety and welfare and there were arrangements in place to deal with foreseeable emergencies. However, we found that the environment was not always safe or adequately maintained and did not readily assist people with their dementia care needs.

Was it effective?

People's needs were well met by staff who were properly recruited and selected. This helped to ensure that people would be cared for by suitably qualified, skilled and experienced staff.

People or their representatives were regularly asked for their views about the care provided. The provider's periodic surveys with, and comment cards from people, showed their overall satisfaction with the care and daily living arrangements at The Gables.

Staff understood people's needs and preferences. People's care plans detailed their known daily living routines, lifestyle preferences and relationships that were important to them. One person's relative said, 'I have felt well involved and informed from the start; They have gone the extra mile to make sure they know who she is and what's important to her.'

Was it Caring?

People experienced care that met their needs and protected their rights. One person's relative told us, 'Very satisfied with the care, couldn't be better, it's like home from home.'

Many people at The Gables were living with dementia. We spent time observing staff interacting, assisting and supporting people and saw that they did this with care and in a way that met with people's needs and known preferences. We saw that staff were respectful and communicated well with people. They approached people at a relaxed pace and in a way that ensured their dignity, choice and privacy. Staff also recognised people's individual reality and supported them at a relaxed pace and in a way that enabled their freedom of movement and action.

Was it responsive?

We saw that some improvements had been made from matters reported by us and in consultation with people using the service or their representatives. These included developing people's care plan records to reflect their choices, views and experiences and their consent to their care.

Information about people's preferences, views and experiences were included in their written care plans to help staff understand them as people in their own right. Care plans gave staff specific guidance to help them understand and respond to people's dementia care needs. This included how their condition affected them.

People knew how to complain and their views and comments were listened to and used to improve the quality of care people received.

Was it well led?

Staff understood their role and responsibilities for meeting people's care needs and reporting any concerns or changes in people's health and safety needs. The provider/managers held regular meetings with staff and provided them with key policy and procedural guidance to support them in their role.

The provider regularly carried out a number of checks of people's care arrangements and other aspects of safety and practice at the home. However, they had not checked whether their arrangements for the prevention and control of infection in the home met with recognised guidance for this, or that this was being properly followed by staff.

We also found that people were not being protected from unsafe equipment and that record keeping and storage was not adequate.

At our inspection on 8 April 2013 we found that changes had been made to ensure that people's preferred routines were recorded including when they wanted to go to bed and get up. We saw that choices were available at mealtimes and that people's nutritional needs were generally being met.

We saw that medication records were accurate and showed that people were receiving their medication as prescribed. We also saw that safe equipment was being provided for people who needed to be lifted.

We found that record keeping had improved and that people's personal information was being stored securely.

We spoke with eight people receiving care, six staff and the manager and also looked at the premises, equipment and records at the home.

We found that people's care did not always meet their individual needs and ensure their welfare and safety. This was because people were not being helped to move around safely and were not always given care in a timely and appropriate way. Also, we found that care planning and delivery was not ensuring people received appropriate care, for example regarding the time they went to bed.

We saw that people were not being offered adequate choice at mealtimes and that arrangements were not fully protecting people who were at risk of inadequate hydration and nutrition.

We saw that staff numbers were adequate to provide care to the people at the home.

We found that medication records were not properly kept and that people may not always be receiving their prescribed medication.

We found that equipment at the home was not always suitable and safe to use and that people's records were not securely stored.

We found that people were not always informed and involved regarding their care. We also found that consent was not always being obtained for people's care, especially if they could not make decisions for themselves.

We saw that people's needs were assessed, and that basic care plans were in people's files. However, we found that the planning and delivery of care did not fully meet the person's individual needs and or ensure the welfare of the person. For example, we found that care plans did not always include details of people's health needs, or guidance about helping people whose behaviour could be challenging.

We saw that health and safety checks were done regularly, including fire checks and drills. We found, however, that several fire doors were wedged open and that this presented a risk to people at The Gables.

We found that staff were properly recruited and trained, and that people were protected from abuse. We also saw that people were asked for their views, and that the quality of care was monitored at The Gables.