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Reports


Inspection carried out on 3 December 2018

During a routine inspection

We carried out an unannounced comprehensive inspection of Red Gables on 3 December 2018. Red Gables is a ‘care home’ that provides care for a maximum of 32 older people. 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.

The accommodation at Red Gables is set out over two floors, access to the upper floor is via stairs or a passenger lift. Some rooms have en-suite facilities. There are shared bathrooms, shower facilities and toilets. People also have access to two lounges, a dining room and a conservatory. On the day of the inspection 25 people were living at Red Gables.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Everyone told us they felt safe living at Red Gables. Risk assessments were completed to identify the level of risk people were at in a range of areas including falls and mobility. Staff knew people well and described to us how they would support people in various situations in order to keep them safe.

We identified some issues with the safety of the environment and have made a recommendation about this in the report. Safety checks relating to fire prevention systems, utilities and the use of equipment were regularly carried out. Personal Emergency Evacuation Plans had been developed for each individual.

Staff told us they enjoyed working at the service and were well supported by the registered manager. They knew people well and treated people as individuals recognising their differences and supporting them according to their preferences. The atmosphere was pleasant and relaxed. Staff and people frequently laughed and chatted together and we observed staff supporting people gently and with patience.

People were supported to take their medicines as prescribed. We identified some shortcomings in how medicines were administered which increased the risk of errors. We have made a recommendation about this in the report. Staff worked with external healthcare professionals to make sure people’s needs were met. Kitchen staff had a comprehensive understanding of people’s dietary requirements and preferences.

The service was in the process of moving care plans from a paper based system to a computerised system. The registered manager had a clear plan for the transition to avoid any information being overlooked. The new system was not as effective in capturing details of people’s emotional well-being and information about how they had spent their time. The registered manager told us this had already been identified and there were plans in place to deliver training to staff to improve this area of recording.

New staff underwent thorough pre-employment background checks and received a comprehensive induction programme. There were sufficient staff to meet people's needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively.

The registered manager and staff understood their role with regards to the Mental Capacity Act (2005) and where applicable the associated Deprivation of Liberty Safeguards.

There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support.

Inspection carried out on 21 June 2016

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 21 June 2016.

Red Gables provides care and accommodation for up to 32 older people who are living with dementia or who may have physical and mental health needs. On the day of the inspection 27 people were living at the care home. The home is on two floors, with access to the upper floor via stairs or a passenger lift. Some rooms have en-suite facilities. There are shared bathrooms, shower facilities and toilets. Communal areas include two lounges, a dining room, a conservatory and an outside seating area.

There was no registered manager in post, however a new manager had been appointed and was in the process of applying for registration. 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 our last inspection on 17 November 2015 we asked the provider to make improvements to how documentation relating to medicine management was being completed. During this inspection we looked to see if improvements had been made and we found that action had been taken.

People told us they felt safe living at the service. Staff knew what action to take if they were concerned someone was being abused or mistreated. Staff had been recruited safely to ensure they were suitable to work with vulnerable people. The provider’s whistleblowing policy protected staff to make disclosures about poor staff conduct or practice, and staff confirmed the manager would take responsive action. People’s consent to care was sought in line with legislation and guidance, to help ensure their human rights were protected.

People’s risks associated with their care were managed to help ensure their freedom was supported and incidents were minimised. People’s environment was assessed for safety and checks were carried out on equipment in line with manufactures guidelines, to ensure they were safe for people to use. People had personal evacuation plans in place to help ensure emergency services would know how to correctly support people, for example in a fire. People were supported by sufficient numbers of staff. People’s medicines were managed safely.

People received care from staff who had undertaken training to meet their needs. However, some staff had not completed all of the provider’s mandatory courses, such as moving and handling. Some external health care professionals were also concerned about the competence and experience of some staff, so discussions were taking place with management. An action plan was in place to address training gaps and the provider was reviewing the organisations training strategy.

Staff told us they felt supported and received supervision and appraisals, which helped to identify their training and development needs.

People liked the meals and were supported and encouraged to maintain a balanced diet. People’s likes, dislikes and specialist diets were catered for and when concerns were identified about people’s nutrition or hydration, action was taken to seek medical advice. People had access to external health services to help maintain their ongoing health and wellbeing.

People were cared for by kind and compassionate staff, who knew them well. Staff and the manager spoke fondly of the people they supported. People were encouraged to be involved in decisions regarding their care. People’s privacy and dignity was promoted.

People received individualised care which met their needs. However, an external health care professional told us, staff did not always contact them in a timely manner, which had resulted in one person being in unnecessary pain. Staff, however had now been more pro-active in contacting them for advice and support more frequently.

People’s independ

Inspection carried out on 17 November 2015

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 19 August 2015. Breaches of legal requirements were found and enforcement action was taken. This was because

people’s care plans were not individualised and did not always give guidance and direction to staff about how to meet people’s care needs. People were not protected from risks associated with their care. People were not protected from risks relating to the environment, and people were at risk of not receiving their medicines as prescribed because documentation relating to medicines was inaccurate. Safe recruitment practices were not always in place as checks were not always carried out to ensure new staff were of good character and safe to work with vulnerable people, and there were not enough staff to meet people’s needs. People were not protected by the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) which meant people’s freedom was not always supported or respected. People received support from staff who did not always have the necessary knowledge, skills and training to meet their needs, and the provider’s systems in place to monitor the quality of service people received were not effective.

After the comprehensive inspection the provider submitted an action plan, to tell us what they would do to meet the legal requirements in relation to the breaches. The provider told us they would make improvements by the 30 November 2015. We undertook this focused inspection on 17 November 2015 to check improvements had been made.

Red Gables provides care and accommodation for up to 32 older people who are living with dementia or who may have physical and mental health needs. On the day of the inspection 22 people were living at the care home.

The home was on two floors, with access to the upper floor via stairs or a passenger lift. Some rooms have en-suite facilities. There were shared bathrooms, shower facilities and toilets. Communal areas included two lounges, a dining room, a conservatory and outside seating area.

The service had a registered manager but they were not working in the home at the time of inspection and Red Gables was being managed by an acting 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.

People were protected by safe recruitment procedures as the necessary checks which determined staff were suitable to work with vulnerable people had been undertaken. There were enough staff to meet people’s needs. People were supported by staff who were provided with the necessary support, knowledge, and training to carry out their role.

People received their medicines as prescribed, but documentation was not always accurate. The additional improvements were due to be completed by 30 November 2015 in line with the provider’s action plan. People were protected from risks associated with their care because staff had guidance and direction about how to meet people’s individual care needs. The environment was regularly assessed and monitored to ensure it was safe at all times.

People’s mental capacity was assessed which meant care was provided by staff who sought people’s consent and cared for people in line with their wishes. People who may be deprived of their liberty had been assessed to determine if this was necessary to keep them safe.

People had care plans in place to address their individual health and social care needs and to give guidance and direction to staff.

Systems had and were continuing to be devised and implemented to help ensure the quality of the service people received was effective and meet their needs. Auditing systems helped to highlight areas which required action and drive continuous improvement across the service.

We found a breach 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.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Red Gables on our website at www.cqc.org.uk.

Inspection carried out on 19 August 2015

During a routine inspection

The inspection took place on 19 August 2015 and was unannounced.

Red Gables provides care and accommodation for up to 32 older people who are living with dementia or who may have physical and mental health needs. The provider also offers a day care facility. On the day of the inspection 22 people were living at the care home.

The home was on two floors, with access to the upper floor via stairs or a passenger lift. Some rooms have en-suite facilities. There were shared bathrooms, shower facilities and toilets. Communal areas included two lounges, a dining room, a conservatory and outside seating area.

The service had a registered manager in post. 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.

After our last inspection in September 2014 we told the provider to take action to make improvements to how the quality of the service was monitored. During this inspection we looked to see if action had been taken and whether improvements had been made. However, we found this had not happened.

People told us staff were kind and caring, and treated them with respect. Relatives told us they were happy with the care their loved ones received. People told us there were not enough staff and because of this, staff did not always have time to talk to them and social activities were limited. People’s social life was not promoted, and some people told us they were bored. People felt staff were competent, however, people were not supported by staff who had the knowledge, skills, experience and training to carry out their role.

People were supported to eat and drink enough and maintain a balanced diet. The chef and kitchen assistant were knowledgeable about people’s individual nutritional needs. People who required assistance with their meals were supported in a kind and dignified way. People told us the food was nice. The design of the menu and the process by which people were asked what they would like to eat, was not reflective of the principles of dementia care. People’s care plans did not always provide detail to staff about how to meet people’s individual nutritional needs.

People felt safe living at Red Gables. The registered manager understood her safeguarding responsibilities; however, staff did not always understand how to recognise abuse and did not know how to raise a safeguarding alert with external agencies. People did not always have a call bell in reach to alert staff if they needed assistance. Some of the call bells were not working correctly. People were not always protected by safe recruitment procedures as the registered manager could not confirm if all employees were subject to necessary checks which determined they were suitable to work with vulnerable people.

People were not protected from risks associated with their care because staff did not have the correct guidance and direction about how to meet people’s individual care needs. People did not have personal evacuation plans in place, which meant people may not be effectively supported in an emergency. The environment was not regularly assessed and monitored to ensure it was safe at all times.

People’s mental capacity was not always being assessed which meant care being provided by staff may not always be in line with people’s wishes. People who may be deprived of their liberty had not been assessed. Staff did not understand how the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) protected people to ensure their freedom was supported and respected. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty.

People did not always have care plans in place to address their individual health and social care needs. People were not involved in the creation of their care plan. People’s care plans were not always legible which meant staff may not always be able to read or understand them. External health professionals did not have any concerns and explained they were contacted appropriately when required.

People’s end of life wishes were not documented and communicated. This meant people’s end of life wishes were not known to staff. People’s medicines were not managed safely. Staff were not always trained to administer medicines, and documentation was inaccurate which meant it was not always clear if people had received their medicines.

People’s confidential and personal information was not always stored securely and the registered manager and staff were not always mindful of the importance of confidentiality when speaking about people’s care and support needs in front of others. People did not always have a lock on their bedroom door and had not been asked if they would like a lock.

People who were living with dementia were not always appropriately supported in a person centred way. People’s care plans did not address dementia care needs and demonstrate how they would like to be supported. The environment was not designed to empower people living with dementia, because of poor signage and a lack of colour contrast. People were not always protected by effective infection control procedures; because the ordering of stock meant that at times there were no paper towels in some of the bathrooms.

People did not know about the complaints procedure but told us if they had any concerns or complaints, they felt confident to speak with the staff or registered manager. Staff felt the registered manager was supportive. Staff felt confident about whistleblowing and told us the registered manager would take action to address any concerns.

The registered manager did not have effective systems and processes in place to ensure people received a high quality of care and people’s needs were being met. There were no opportunities for people to provide their feedback about the service, to help ensure the service was meeting their needs as well as assisting with continuous improvement. The Commission was notified appropriately, for example in the event of a person dying or experiencing injury.

We found 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 5 September 2014

During a routine inspection

This was a follow up inspection to monitor progress made since our last inspection in May 2014 when two compliance actions were set.

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them and observing care practices.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

One the day of our inspection we found the service to be safe.

People told us they felt safe. Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Quality assurance processes were not robust and need improvement. This will reduce the risks to people and help the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Red Gables alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Red Gables had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people’s needs were met.

Is the service effective?

One the day of our inspection we found the service to be effective.

People’s health and care needs were assessed with them, although people were not involved in writing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were not up-to-date as they were not regularly reviewed.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

The quality of recording seen was of a satisfactory standard but required greater consistency to enable care staff to use the information correctly.

Is the service caring?

One the day of our inspection we found the service to be caring.

At our previous inspection we spoke with four people and one relative and asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “wonderful”, “Staff are very friendly” and “Very considerate carers”. When speaking with staff it was clear that they genuinely cared for the people they supported.

People’s preferences and interests had been recorded and some life histories were evident.

Red Gables had regular support from the local GPs and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

One the day of our inspection we found the service to be responsive.

The care records showed some evidence of the lifestyle of the people who lived at Red Gables and we observed that staff spent one-to-one time with people throughout the day.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

One the day of our inspection we found the service in need of improvement.

We met with the registered manager. We saw minutes of meetings held with the staff. This showed the management consulted with staff to gain their views and experiences and improve support for people who lived at the service. We noted that these meetings were not held at regular intervals.

The service had a quality assurance system which we considered needed a more comprehensive and consistent approach. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and but were not clear about the quality assurance processes. This did not help to ensure that people received a good quality service at all times.

Inspection carried out on 12 May 2014

During a routine inspection

We gathered evidence against the outcomes we inspected to help answer our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? We gathered information from people who used the service by talking with them and observing care practices.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe. Systems were in place to help the manager and staff team learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. Quality assurance processes were not robust and need improvement. This will reduce the risks to people and help the service to continually improve. Staff showed a good understanding of the care needs of the people they supported.

Red Gables alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service. Red Gables had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DOLS). This helped to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed with them, although people were not involved in writing their plans of care. During our inspection it was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people’s needs.

Specialist dietary needs had been identified where required. Care plans were not up-to-date as they were not regularly reviewed.

We saw that there was good liaison and communication with other professionals and agencies to ensure people’s care needs were met.

The quality of recording seen was of a satisfactory standard but required greater consistency to enable care staff to use the information correctly.

Is the service caring?

We spoke with four people and one relative and asked them for their opinions about the staff that supported them. Feedback from people was positive, for example, “wonderful”, “Staff are very friendly” and “Very considerate carers”. When speaking with staff it was clear that they genuinely cared for the people they supported.

People’s preferences and interests had been recorded and some life histories were evident.

Red Gables had regular support from the local GPs and other visiting health professionals. This ensured people received appropriate care in a timely way.

Is the service responsive?

The care records showed some evidence of the lifestyle of the people who lived at Red Gables and we observed that staff spent one-to-one time with people throughout the day.

The service worked well with other agencies and services to make sure people received care in a coherent way.

Is the service well-led?

We met with the registered manager. We saw minutes of meetings held with the staff. This showed the management consulted with staff to gain their views and experiences and improve support for people who lived at the service. We noted that these meetings were not held at regular intervals.

The service had a quality assurance system which we considered needed a more comprehensive and consistent approach. Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and but were not clear about the quality assurance processes. This did not help to ensure that people received a good quality service at all times.

Inspection carried out on 12 February 2014

During an inspection to make sure that the improvements required had been made

Red Gables provided care and support to a maximum of 32 people. There were 23 people using the service at the time of our inspection. This was a follow up inspection to check if improvements had been made in the areas of non-compliance identified during the last inspection in September 2013. We found significant improvements had been made in respecting people’s dignity and independence, the safety of the environment and levels of staff on duty.

We saw people’s privacy and dignity were being maintained. We heard people who used the service being asked where they would like to sit and if they were warm enough. We heard people being given directions to the toilet facilities helping to maintain their independence.

The premises and environment were undergoing improvements such as the fitting of new windows and a new call bell system. The home was clean and tidy.

There was enough skilled and experienced staff on duty. People we spoke with told us they did not have to wait long if they needed assistance. Staff told us the staffing levels had improved and they enjoyed working at the home.

Inspection carried out on 17 September 2013

During a routine inspection

Red Gables provided care and support to a maximum of 32 people. There were 23 people who used the service at the time of our inspection. We spoke in depth with four people who used the service and two visiting relatives. Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs.

We saw people’s privacy and dignity were being maintained. People we spoke with told us: “they’re lovely, very good to me” they are “kind, all very nice and obliging”. We heard care workers knocking on people’s doors before they entered their rooms.

We found peoples’ views and experiences had not always been taken into account in the way the service was provided and delivered in relation to their care.

We saw care plans were detailed and gave direction as to the care and support people needed. They had been regularly reviewed.

People who used the service were protected from the risk of abuse, because the staff had received training. Staff we spoke to knew how to identify abuse and how to report their concerns to the local authority.

The medication systems we saw in place meant people were protected against the risks associated with medicines because the registered manager had appropriate arrangements in place to manage medicines.

The premises were not being adequately maintained. There was no evidence of a planned maintenance programme. The call bell system was not working efficiently at all times. In some rooms people could not reach their call bells as no extension cable was provided.

We saw staff were able to meet people’s care needs but were not able to meet their social needs. There was no activity organiser and when care workers were free to spend time with people who used the service they were doing laundry as there were no dedicated laundry staff.