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Archived: The Gable Requires improvement

The provider of this service changed - see old profile

The provider of this service changed - see new profile

Reports


Inspection carried out on 1 October 2018

During a routine inspection

We carried out an inspection of The Gable on 1 and 2 October 2018. The first day was unannounced. The Gable is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The Gable provides accommodation and care and support for up to six people with a learning disability. The service does not provide nursing care. There were six people living in the home at the time of the inspection.

At the time of our inspection, we were informed the ownership of the home had change. Appropriate applications had been forwarded to CQC for consideration.This meant new systems and records were being introduced at the time of our inspection.

The Gable is a large end terrace in a residential area close to Burnley town centre. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in place. 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 on 16 and17 November, the overall rating of the service was 'requires improvement' and our findings demonstrated there were three breaches of the regulations in respect of unsafe management of medication, failing to ensure risks to people's wellbeing and safety were assessed and managed and a lack of compliance with the Mental Capacity Act 2005. The service was rated "Requires Improvement." Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service.

At this inspection we found the provider was in breach of five regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. They related to the provider having insufficient risk assessments, unsafe processes for the management of medication, a lack of appropriate training for new staff, lack of oversight of the service and a lack of compliance with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection, the service was rated as overall 'requires improvement,' at this inspection the rating had remained as 'requires improvement.'

We were aware the proposed new provider was committed to an extensive programme of development which would improve people's lives. This included changes to the environment, policies and procedures and to the records and systems. During this inspection, we found changes were in progress.

We found there were management and leadership arrangements in place to support the day to day running of the home. However, the provider needed to ensure better oversight of the service to ensure they were meeting the regulations and that the service was effectively managed.

There had been improvements to the management of medication since our last inspection and an updated medication policy, including "covert medication" guidance was due to be issued by the new provider.

We found that people's concerns and complaints were not always acted upon and risks around individuals were not fully assessed and managed safely. A safeguarding alert was raised during the inspection, due to concerns raised by a person living at the home.

People were supported to have choice and control of their lives and staff supported them in the least res

Inspection carried out on 16 November 2017

During a routine inspection

This inspection was carried out on 16 and 17 November 2017. The first day of the inspection was unannounced.

The Gable is a care home which is registered to provide care and accommodation for up to six adults with a learning disability and does not provide nursing care. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. The Gable is an adapted building in a residential area in Burnley. At the time of the inspection there were six people accommodated at the service.

At the time of the inspection, the service was without 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. There was a manager in post who had commenced the initial process for registration, but had not yet submitted an application with the Commission.

At our last inspection on 5 January 2015 the overall rating of the service was ‘Good’ and there were no breaches of the regulations. At this inspection we found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. They related to the provider having unsafe processes for the management of medicines, insufficient risk assessments and risk management processes and a lack of compliance with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report.

We found there were management and leadership arrangements in place to support the day to day running of the service. However the providers need to have better oversight of the service and improved checking systems, to make sure the service is safely and effectively run.

Systems were in place to maintain a safe environment for people who used the service and others. However we found some matters were in need of attention.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. There were enough staff available to provide care and support and we were told staffing arrangements were kept under review.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on safeguarding and protection matters.

We found people were supported to make their own decisions and choices. They were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were satisfied with the meals provided at The Gable. Arrangements were in place to offer a balanced diet. People were actively involved with devising menus, which meant they could make choices on the meals provided.

People made positive comments about the care and support they received from staff. We observed positive and respectful interactions between people using the service and staff.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities and preferences before they used the service.

Each person had a care plan, describing their individual needs and choices. This provided guidance for staff on how to provide support. People had been involved with planning and reviewing their care. People’s privacy, individuality and dignity was respected.

People were supported with their hobbies and interests, including activities in the local community and to keep in touch with their relatives and friends. Their well-being was monitored and reviews of their needs were held.

There were processes in place for dealing with complaints. There was a formal procedure to manage, inve

Inspection carried out on 15 January 2015

During a routine inspection

We undertook an unannounced inspection on 15 January 2015. The Gable provides accommodation and support to people with a learning disability. The service can accommodate up to six people. At the time of our inspection five people were using the service.

At our last inspection on 19 July 2013 found there were no breaches of regulations or concerns identified at the visit.

There was a registered manager in day to day charge 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 2008 and associated Regulations about how the service is run.

CQC is required by law to monitor the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure the rights of people who may lack capacity to make safe decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need. Staff had received training about the MCA and DoLS and had a good understanding of the procedures to follow. We found there had been no DoLS applications, however, the registered manager was aware of the process if this was found necessary in the future.

People living in the home told us they felt safe there and did not have any concerns about the way they were supported. One person told us, “We all get on and the staff are like our family.” A relative said, “I have never had any worries about my son being here. The quality of care provided by the staff is not seen that often. They really do care.” People living in the home were given easy read guidance about how to report abuse and had received information and advice about keeping safe in the local community.

Staff members communicated with people effectively. Staff treated people in a caring, kind and respectful way. They knew the people they cared for and supported well and always used people’s preferred names.

People were involved in deciding what food and drink they had. They were supported to access healthcare services to maintain and promote their health and well-being. They were encouraged to make their rooms at the home their own personal space. People and their relatives had been involved in the development of their care plans which were reviewed on a six monthly basis, or more frequently if required.

People were supported in a range of interests, both as during activities together or on an individual basis, which suited their needs. They were encouraged to take part in activities outside of the home to enable them to access their local community.

There were enough qualified, skilled and experienced staff to meet people’s needs. For staff already employed by the service all necessary checks had been completed before new staff members had started work at the home and they had completed an induction programme when they started work. Staff members received training in areas that improved their capability in providing care and support to people who lived at the home and had regular supervision and appraisal meetings with the manager at which their performance and development were discussed

Staff members were able to demonstrate a good understanding of procedures in connection with the prevention of abuse. Risk assessments in respect of the home and the provision of care and support to people had been undertaken, regularly reviewed and steps taken to reduce any on-going risk.

The provider had systems in place to ensure that medicines were administered and disposed of safely. All medicines were stored securely.

The provider had an effective system to regularly assess and monitor the quality of service that people received and an effective complaints system.

Inspection carried out on 19 July 2013

During a routine inspection

We spoke with the people living in the home who told us they were happy with the care and support they received. Comments included, "It's a lovely place; I'm very comfortable", "I can do what I want to do and can get help if I need to" and "I'm very well looked after;"

Comments included, "I like the food; I can choose what I want and we go shopping with a list that includes all our requests".

Records we looked at showed people's needs were assessed and care and treatment was planned and delivered in line with the individual care plan. We found that the care plans were accompanied by risk assessments and risk management plans to ensure people were protected from unsafe care practices.

People we spoke with told us they received appropriate support with their medication. We found evidence that there were effective systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from inappropriate staff.

Inspection carried out on 14 January 2013

During a routine inspection

One person told us that "Staff are so helpful, I feel very supported." People told us the food was nice, that they had a choice of what to eat, and they had enough to eat and drink. Another person told us "There is a very good atmosphere here, staff think of us all the time and do everything to make us happy."

People were provided with care plans that are regularly reviewed so that people have the most appropriate support to meet their needs and if these needs change, the support they receive is amended to reflect those needs.

People said they felt safe living in the home and were able to discuss concerns or issues with the staff if they wished to. We saw that the people using the service are involved in planning their care and are in control of how their support is provided for them. Risk assessments are reviewed regularly in respect of the person's needs, the environment and behaviour so that service users and staff are safeguarded.

We saw that there was access to a number of external activities and people were able to regularly access the local community.

We looked around the location and found that there has been an ongoing programme of refurbishment and decoration to improve the fabric of the home.

Inspection carried out on 25 October 2011

During a routine inspection

We were told that because the care is well planned and the manager and care staff take time to get to know the individuals the needs of people using the service were being met. This was demonstrated in many ways and comments made during our discussions supported this view.

Comments supporting this view included:�They talk to me about my day to day things and ask if anything has changed or do I want things doing differently. I feel really well looked after."

�I am very happy with my care. I like the food and my room is lovely and the staff very friendly and welcoming�.

�They are very kind and thoughtful people who cannot do enough for you�.

�Good food, good staff, excellent care�.