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Archived: Green Gables Care Home Good

The provider of this service changed - see old profile

The provider of this service changed - see new profile


Inspection carried out on 15 and 16 July 2015

During a routine inspection

This inspection was carried out on 15 and 16 July 2015 and was unannounced.

We last inspected Green Gables Care Home in August 2014. At that time we found that the registered provider was not compliant with all the regulations and took enforcement action in relation to people’s care and welfare. At this inspection we looked to see what action the provider had taken to become compliant. We that the provider had completed the actions we required them to take.

Green Gables Care Home provides accommodation for up to 18 older people and people living with dementia. The service is a converted domestic property. Accommodation is arranged over three floors. Stair lifts are available to assist people to get to the upper floors. The service has 16 single and one double bedroom, which people can choose to share. There were 17 people living at the service at the time of our inspection.

A registered manager was working at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager was not clear about their responsibilities under Deprivation of Liberty Safeguards (DoLS). Arrangements were not in place to check if people were at risk of being deprived of their liberty and apply for DoLS authorisations. Systems were in operation to obtain consent from people, however, processes to assess people’s capacity to make decisions and to make decisions in people’s best interests were not in place. Staff assumed people had capacity and supported them to make decisions and choices.

The registered manager provided strong leadership to the staff and had oversight, with the provider, of all areas of the service. Staff were motivated and felt supported by the registered manager and provider. The staff team had a clear vision of the aims of the service and made sure these were delivered. Staff told us the provider and registered manager were approachable and they were confident to raise any concerns they had with them. Processes were in place to learn from incidents and accidents and continually improve the service.

There were enough staff, who knew people well, to meet peoples’ needs at all times. The needs of people had been considered when deciding how many staff were required on each shift. Staff had the time and skills to provide the care and support people needed. Staff were clear about their roles and responsibilities and were accountable for their actions.

Staff recruitment systems were in place and information about staff had been obtained to make sure staff did not pose a risk to people. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff were supported to provide good quality care and support. The registered manager had a training plan in place to keep staff skills and knowledge up to date. Most staff held recognised qualifications in care. Staff met regularly with the registered manager to discuss their role and practice and any concerns they had.

Staff knew the possible signs of abuse and were confident to raise concerns they had with the registered manager or the local authority safeguarding team. Plans were in place and staff knew how to keep people safe in an emergency.

People’s needs had been assessed to identify the care they required. Care and support was planned and reviewed to keep people safe and support them to be as independent as possible. People and their relatives were involved in planning their care.

People were supported to participate in hobbies and activities they enjoyed, at the service and in their local community, such as bingo. Possible risks to people had been identified and were managed to keep people as safe as possible.

People got the medicines they needed to keep them safe and well. Action was taken to identify changes in people’s health, including regular health checks. People were supported by staff to receive the care and treatment they needed to keep them as safe and well as possible.

People were involved in choosing their own food and drinks and were supported to have a balanced diet. Choices were offered to people in ways they understood. Staff listened to what people told them and responded appropriately. People were treated with respect and their privacy and dignity was maintained.

People and their relatives were confident to raise concerns and complaints about the service. These were logged and investigated and people had received a satisfactory response.

The registered manager completed regular checks of the quality of the service provided. When shortfalls were found action was taken quickly to address these and prevent them from occurring again. People, their relatives and staff were asked about their experiences of the care. These were used to improve and develop the service.

The environment was safe, clean and homely. Maintenance and refurbishment plans were in place and areas of the home had recently been redecorated and refurbished.

Accurate records were kept about the care and support people received and about the day to day running of the service and provided staff with the information they needed to provide safe and consistent care and support to people.

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.

Inspection carried out on 12, 13 August 2014

During a routine inspection

We carried out an unannounced inspection in order to check up on compliance with a compliance action made at our last inspection.

One inspector visited the home over the course of two days.

We spoke with the people who used the service, people�s friends and relatives, the manager and care staff. We also observed staff supporting people with their daily activities.

Green Gables Care Home can provide accommodation for up to 18 older people. There were 18 people using the service at the time of our inspection.

We considered our inspection findings to answer questions we always ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people and the management team and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

A process was in place to undertake assessments and to plan care with the aim of ensuring that people received safe and appropriate care. We found that this had been completed for five of the 18 people using the service. However, some assessments had not been completed when people�s needs had changed and care was not consistently planned to meet people�s assessed needs. More information was required in some risk assessments and care plans to support staff to provide safe and consistent care.

People were supported to be able to eat and drink sufficient amounts to meet their needs. Assessments of people�s nutrition needs were completed and action was taken to offer people a suitable diet to meet their needs. People told us that the food at the service was good and they were given choices of what they ate at each meal.

A robust recruitment system was in place and had been followed when new staff had been recruited. Staff had been the subject of criminal records and other checks to ensure they were of good character and had the skills to meet people�s needs. An induction process was followed to provide new staff with the skills and knowledge they required to provide the service safely.

Is the service effective?

Since our last inspection five people�s care plans had been revised to include more information and guidance for staff. Every assessment and care plan area had been regularly reviewed; however amendments had not always been made to ensure that care plans remained current.

Staff knew people well, they responded to people�s requests and offered them choices. Staff knew what people were able to do for themselves and supported them to remain independent.

There was a structured system in place to ask people using the service, their relatives and staff for their views about the service and act upon them. The provider operated an effective system to regularly assess and monitor the quality of the service provided. This included regular monitoring of the environment and the care provided by staff.

Is the service caring?

People were supported by kind and attentive staff. Staff showed patience and gave encouragement when supporting people. People we spoke with said they liked the staff and that they were kind and caring. One person�s relative told us that the staff were very friendly and reacted to people�s emotions. People and their relatives told us the service felt like a big family.

People were supported to attend health appointments, such as, doctors or dentists. The service worked closely with health and social care professionals to maintain and improve people's health and well-being.

We saw positive interactions from staff when supporting people throughout our inspection.

Is the service responsive?

The service had taken some action to become compliant and improve the service people received since our last inspection. However, further action was required to ensure they identified and responded to people�s needs. For example, further assessments of people�s needs were not completed when pre admission assessments identified that people were at risk. Care was not planned for people during the first month of them receiving a service from Green Gables Care Home.

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

The manager had a process in place to employ sufficient staff, at all times, to meet the assessed needs of people using the service. Such as additional staff in support people to get up and go to bed. Staff were attentive to people using the service and responded promptly when needed.

The service had a complaints process in place and information had been given to people about how to make a complaint. Complaints received had been acted on and action had been taken to address people�s concerns. People and their relatives told us they felt confident to raise concerns with the service and thought the manager would take action to address their concerns.

Is the service well-led?

Since our last inspection a duty manager had been appointed. Staff told us they felt supported by the manager and the duty manager and could contact them for advice and support. A process was in place to identify the staff member leading each shift. Staff we spoke with were clear about their role and responsibilities.

Audits of the care plans and other systems were completed to assess the quality of the care being provided. Where shortfalls had been found action had not always been taken to protect people using the service.

Inspection carried out on 28 February 2014

During an inspection in response to concerns

There were eighteen people living at Green Gables when we completed our inspection, we spoke with 4 of them. People said they were happy living at the home, one person said, �Staff are always about and ready to help you�. Another person said, �Everything I want is done for me, I am very happy to be here�.

People were encouraged to remain independent and had been involved in planning their care with their families. We found that the staff knew people well. Relatives told us, �The staff work really hard, for the benefit of the people living here�. �They have some good activities, they try to involve people to do crafts�. �I have been invited to meetings and staff listen to what I say�.

We found that care plans contained information about some of the support and care that people needed, however they did not show how risks were managed to make sure people were as safe as possible.

People told us that staff were kind and caring and they felt safe and well looked after. One person told us, �We are treated like royalty�. People looked comfortable and at ease with each other and staff. Staff understood how to protect people and were confident to raise any concerns they had with the manager and others.

People received their medicines in a safe way. The service had processes in place that ensured medicines were available when people needed them. We found that staff had received appropriate training to administer medicines.

At the time of the inspection the service we saw that at times, they did not have sufficient staff on duty to meet people needs. The manager took action during the inspection to arrange for additional staff in the afternoons.

The service had a process in place to obtain feedback about the quality of the service people received from people using the service, their relatives and staff. However, they did not consistently evaluate and respond to this information to improve the quality and safety of the service.

Inspection carried out on 22 August 2013

During a routine inspection

We spoke with people who used the service, relatives and staff at the home. People were confident in the service's ability to provide the support they needed. One person told us "This is a very good home", and another person said "The staff are lovely". We spoke with relatives who expressed some concerns about the leadership of the care staff when the manager was busy with administrative duties. We found that the manager had identified this as an issue and had started the recruitment process for an experienced senior carer to support the carers during the day.

We saw evidence to demonstrate that staff had kept their knowledge and skills up to date, with regular training, as well as supervision and appraisal by the manager.

People told us that the staff always checked with them before attempting to provide any care or support. We found evidence of people's consent being sought for changes to their care, as well as for provision of support in daily activities.

We saw evidence of monitoring and regular evaluations of the support that was provided, together with involvement and liaison with relatives and various health professionals, to ensure they were kept informed of changes in people's conditions when necessary.

We found that the provider had implemented ways to gather feedback on the service from people, as well as informal discussions with people about how to improve the service.

Inspection carried out on 15 November 2012

During a routine inspection

We spoke with four people out of 15 at the home at the time of the inspection.

One person told us that �staff are first class here�, Another person told us that �we all get to speak our mind here�.

All the people we spoke with told us that they were happy at the home, and appreciated the support given by staff. All the people we spoke with told us that staff regularly asked them if they were happy with the care and support they received, and one person told us �there was a lovely atmosphere at the home�.

We observed staff talking with people in a polite and relaxed manner, and found that staff addressed each person by their preferred name.

Inspection carried out on 9 December 2011

During an inspection in response to concerns

People told us that they were generally satisfied with the care they received at the home. One person told us that she would not change anything about the home. Another person told us that the home was lovely, clean, and that she liked the food. We saw that the home was clean and decorated with people�s personal belongings, and people told us that it was a home from home.