Archived: Gables Care Home

Updated 26 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Gables Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Gables Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The provider was also the registered manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.

During the inspection

We spoke with four people to gain their views on the quality of care provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with the provider four members of staff. We reviewed information held in five people's care plans, three staff recruitment files, medication records and other paperwork related to the running of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at staff training and supervision records.

Updated 26 May 2023

About the service

Gables Care Home is a care home providing accommodation and personal care to seven people aged 65 and older with a mental health diagnosis, dementia and a learning disability. People live in one adapted building.

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

Risks to people were not always assessed, monitored and managed safely. There was no formal recording of people’s behaviours to look for trends and themes. The management of medicines required some improvements around competency assessments and correct processes in place when errors had occurred. All other aspects of the administration of medicines was undertaken in a safe way.

The provider and staff had not received adequate training and supervision in relation to their role.

There was a lack of meaningful activities for people and staff lacked an understanding of people’s needs. Care plans lacked detailed guidance and information on people’s backgrounds and family history. There were no end of life care plans in place.

People were not always being treated in a caring and dignified way and people’s choices were at times restricted. People’s nutrition and hydration was being monitored; however, choices around meals and drinks were at times restricted. We have made a recommendation around this.

Quality assurance and governance systems were not effective in making sure risks to people were managed safely. Staff had not always been supported to understand and fulfil their expected roles and responsibilities.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of all the domains:

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

Not everyone was being supported in a way that enabled them to have choice and control in their daily lives. We found people had restrictions placed on them in relation to accessing the kitchen. There had not been an assessment of any risk associated with this.

Right care:

Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. People did not always have access to meaningful and person-centred activities.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives. There were institutionalised practices where care was decided for people rather then people being supported to remain independent.

Rating at last inspection and update

The last two ratings for this service were Inadequate (published 07 June 2021 and 17 August 2021) and there were breaches of regulation. At this inspection we found improvements had not been made and the provider remained in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating and to follow up on action we told the provider to take at the last 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, Caring, Responsive and Well Led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to the safe care and treatment, training and supervisions of staff, lack of adherence to the principles of the mental capacity act, people not always being treated in a caring and dignified way, the lack of meaningful activities, staff being aware of people’s care, and the lack of robust oversight of the care provision at this inspection.

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 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.

The overall rating for this service ‘Inadequate’ and the service remains 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 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.

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