We carried out a review of the data available to us about Three Gables Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Three Gables Residential Care Home, you can give feedback on this service.
We found the following examples of good practice.
The registered manager demonstrated a passion and understanding for infection control. They had trained to be an Infection Control Champion in a Local Authority programme. There were robust infection control policies and procedures in place and continuous cleaning by care and domestic staff.
People had been supported to remain in contact with their loved ones, despite the home having an outbreak of infection. The staff were supporting and following the most up to date guidance about Essential Care Givers and had maximised areas of the home for visiting. This included the use of a large garden and transforming a shed into a visiting pod. People had also thoroughly enjoyed a garden party, to which relatives and the local MP attended.
People’s mental health had been closely monitored during the outbreak and staff had found ways to support people when they didn’t understand or became distressed about social distancing. The registered manager had conducted wellbeing supervisions with staff and offered them the services of an external counsellor.
Three Gables is a residential care home that was providing personal care for up to 19 people aged 65 and over, some living with dementia. At the time of the inspection, 16 people were using the service. Two of these people were staying at the service on a short-term basis, otherwise known as respite.
People’s experience of using this service:
We saw lots of improvements had been made from the previous inspection with regard to audit processes and people’s documentation. Care plans were now up to date with people’s needs, preferences and routines so that staff had guidance in how they should be supported.
People told us they felt happy and safe at the home. There were enough staff to meet their needs and they were recruited in a safe way. Risks to people had been identified and reviewed regularly and staff knew what support was needed to minimise risks. Regular checks were completed on the environment to ensure it was safe for people to live in. People also received their medicines safely from staff that were knowledgeable and trained to do so.
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 processes in the service supported this practice.
Staff had received a variety of different training courses to ensure they had the skills and knowledge to meet people’s needs. Their skills were regularly assessed through supervision, competencies and observations of the care they provided.
People’s nutritional and hydrational needs were met. They told us they enjoyed the food and there was lots of choice. We observed meal times to be a social experience for people, with a cheerful and engaging atmosphere. Staff made appropriate referrals to health and social care professionals to seek advice about people’s needs and wellbeing.
Everyone we spoke to was consistent in their views that staff were kind and caring. One person said, “I’m very lucky living here. Staff are lovely and very helpful.” A relative also told us, “We really feel like we’ve found a diamond here. They seem to love my relative. Everyone is very kind and gentle.” Staff knew people, their support and needs and preferences well and promoted person centred care.
Although there had not been any official complaints, the registered manager and staff told us this was because they talked to people all the time and addressed concerns quickly. People were confident that any concerns they had would be managed well and relatives were also knowledgeable of who they could speak to. People’s communication needs were known to staff and additional tools provided to help people communicate their decisions.
People, relatives and a professional told us that they thought the service was well-led. The registered manager reflected that working in partnership was important to improve the lives of people and were keen to promote continued learning and growth.
Rating at last inspection:
The service’s previous inspection was rated Requires Improvement. (Published June 2018) At this inspection, concerns had been addressed and the rating had improved to Good.
Why we inspected:
This was a planned inspection based on the rating at the last inspection.
Follow up:
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made improvements, and check that the service now met legal requirements. We found some improvements had been made, however the breach of regulation had not been met.
Three Gables Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or 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. Three Gables Residential Care Home provides accommodation and personal care for up to 19 people in one adapted building. At the time of the inspection there were 17 people living there. People living at the home were older people some of who were living with mental ill health including a dementia type illness. People had a range of needs associated with old age and their health.
There was a registered manager at the service, who was also the provider. 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 improvements were needed to ensure people’s records reflected the care and support they required and received. Risks assessments were in place however these did not always include all information staff may need. However, staff had a good understanding of the risks associated with the people they looked after and their care and support needs. They gave us detailed and consistent information about how they supported people to remain safe.
There was a quality assurance system in place which helped identify areas that needed to be improved. People, visitors and staff spoke highly of the provider and there was a positive culture at the service.
Systems were in place to ensure accidents and incidents were safely managed and action was taken to prevent a reoccurrence. Staff understood the procedures and what steps to take to safeguard people from the risk of abuse, harm or discrimination.
Staff knew people really well. This enabled them to support people as individuals and provide good person-centred care. There was a variety of meaningful activities taking place each day. People were supported to take part in these or engage in other activities of their choice.
People were treated with kindness, understanding and good humour. Staff were patient and supported people at their own pace and respected people’s dignity and right to privacy. People were supported to make their own decisions and choices throughout the day.
There were enough staff, who had been appropriately recruited, working at the home. Medicines were well managed and systems were in place to ensure medicines were ordered, stored, given and disposed of safely.
Staff had received training and supervision that helped support them to deliver care in a way that responded to people's individual needs.
People were supported to have choice and control of their lives and staff support them in the least restrictive way possible. The policies and systems in the service support this practice.
Staff ensured people had access to external healthcare professionals, such as the GP and district nurses as necessary. Staff monitored people's nutritional needs and people had access to a choice of food and drink that met their needs and preferences.
There was a complaints policy in place. People and visitors told us they would raise any concerns with staff.
There is a registered manager at the home who is also one of the partners of the business. 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.
This was an unannounced inspection and took place on 24 and 25 April 2017. We returned on 8 May 2017 to meet with the registered manager who had been away at the time of the inspection. This was the first inspection at Three Gables since the new provider had been registered with CQC.
People were supported by staff who knew them well and were committed to providing them with kind and compassionate care. Feedback received from people was positive about the care, the approach of the staff and atmosphere in the home. People and staff had benefitted from an open and positive culture at the home.
There was a quality assurance system in place to help identify areas where improvements were needed. This required more time to become fully embedded into everyday practice to become fully effective.
There were risk assessments in place however; these did not clearly reflect all the risks identified in some people’s risk assessments. The information about one person’s diet and some information about people’s skin integrity was conflicting. There was limited guidance in place for people who needed ‘as required’ (PRN) medicines, other areas of medicines systems were managed safely.
People were supported by staff who were kind and caring. They had a good understanding of people’s individual needs and choices. This enabled them to provide good person-centred care. However people’s records did not always reflect the care people required or received.
Staff were busy throughout the day and attentive to people’s needs. However, we found at mealtimes there were not enough staff to support people in a timely way.
There was an ongoing training and supervision programme in place. This included observations of staff in practice. Staff told us they felt supported through the supervision process. Appropriate checks were undertaken to ensure suitable staff were employed to work at the service.
Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) had been submitted when required. However, there was not always clear information about how people who lacked capacity were supported to make decisions or how restrictions may affect them.
People were supported to eat and drink a variety of food of their choice and nutritional assessments were in place. However, some people did not receive the support they required to eat their meal in a timely and undistracted way.
Staff had a clear understanding of the procedures and their responsibilities to safeguard people from abuse. They were able to tell us about the types of abuse and actions they would take to protect people.
People were supported to have access to healthcare services this included the GP, district nurse and chiropodist. Feedback from visiting healthcare professionals was positive.
We found a breach of the Regulations 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 this report.