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Inspection Summary


Overall summary & rating

Requires improvement

Updated 18 July 2018

We carried out an unannounced inspection on 4 June 2018.

White Gables 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.

White Gables is located on the edge of a village on the outskirts of Lincoln. It accommodates up to 55 people many of whom are living with dementia requiring high levels of care and nursing. The accommodation is provided on one floor and the building is separated into three separate units called Cedar, Castle and Cathedral. Cedar provides mainly residential care whilst Castle and Cathedral provides for people requiring nursing care. On the day of the inspection there were 42 people living at the home.

At our last inspection in December 2015 we rated the service good. At this inspection, we rated the service as requires improvement. Safe, caring, and well led remained good; however, effective and responsive required improvement. This is the first time the service has been rated Requires Improvement.

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.

Systems and processes were in place to ensure people were protected from abuse and people told us they felt safe at the home. Risk assessments were completed to identify risks to people’s health and safety but care plans did not always reflect the actions required and we found an example of a delay in obtaining a piece of equipment required to improve a person’s safety.

There was a good culture of incident reporting and staff were able to speak up about concerns. Infection risks were controlled and managed well and checks of the premises were in place to maintain the safety of the buildings and equipment. People received their medicines as prescribed and arrangements were in place for the ordering and supply of people’s medicines.

People were supported to have maximum choice and control of their lives. Although staff supported people in the least restrictive way, they did not always have a full understanding of the Mental Capacity Act (2005) and specific best interest decision making was not always documented.

When people required support and encouragement with their eating and drinking, we had some concerns as to whether they were receiving sufficient fluids and whether sufficient steps were taken to maximise their nutritional intake. Improvements could be made to the care of people’s mouths particularly when they were not able to maintain a good oral intake.

People were supported to access health care and staff sought the advice of a specialist healthcare professionals were necessary. They worked well with other services and acted on the advice provided.

Staff were friendly, encouraging and caring in their approach. People and their relatives praised the attitude of staff and their kindness. They protected people’s privacy and dignity and respected their views and choices.

People and their relatives were involved in the development of their care plans. However, some care plans did not contain some key information and the amount of information about their life history and previous interests was sometimes limited.

People’s views were listened to and acted upon and complaints were dealt with responsively and effectively.

The home was well-led by a registered manager. People using the service, their relatives and staff praised the registered manager and the support they provided. People and staff were encouraged to contribute to the development of the service. Effective auditing processes were in place to monitor the quality of the service. The registered manager carried out their role in line with their registration with the CQC.

Inspection areas

Safe

Good

Updated 18 July 2018

The service remains safe.

Risks to people’s health and safety were assessed; however care plans did not always provide sufficient information about the actions to be taken to reduce these risks.

Information and training for staff on how to support people with distressed behaviour was not consistently provided

Overall medicines were managed safely and in line with requirements. People received their medicines as prescribed and staff kept accurate records of medicines administration.

Effective safeguarding systems, policies and procedures were in place and safeguarding concerns were reported and managed appropriately.

People were protected from the risk of infection.

Effective

Requires improvement

Updated 18 July 2018

The service was not consistently effective.

Mental capacity assessments and best interest decisions were not always completed or the decision to which they referred was not clear. However, staff supported people in the least restrictive way.

Daily care records did not always provide evidence that planned care was provided in line with the requirements identified in people’s care records. We also had concerns as to whether people were supported to drink sufficiently to meet their needs. The quality of the food could be improved.

People were supported to access health care to meet their needs.

Caring

Good

Updated 18 July 2018

The service remains caring.

People were treated with dignity, respect and kindness during all interactions with staff. Their relationships with staff were positive and they sought and gained reassurance from staff.

People, their relatives and an external professional praised staff for their care kindness and friendly approach.

People were encouraged to maintain their independence.

Responsive

Requires improvement

Updated 18 July 2018

The service was not always responsive.

People's care records did not always contain detailed and up to date information on their care and information about their previous life history and interests were limited.

Improvements were required to the oral care people received particularly when they were unable to maintain a good oral intake.

People and their relatives were involved in the development of their care plans.

Complaints were dealt with consistently and appropriately. People and their relatives felt confident that any concerns raised would be dealt with immediately.

Well-led

Good

Updated 18 July 2018

The service remains well led

The registered manager was experienced, responsive and committed to the development and improvement of services. Staff respected the manager and said they were supportive and fair.

Audits were in place to monitor the quality of care and services provided and action plans were developed to address issues.

The views of staff, people using the service and their relatives were listened to and they were encouraged to identify new ideas and new ways of working.