The Gables

Updated 21 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 4 inspectors.

Service and service type

The Gables is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Gables is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 6 November 2023 and ended on 15 November 2023. We visited the location’s home on 6 November 2023 and 9 November 2023.

What we did before the inspection

We reviewed information we had received about the service since our last inspection and sought feedback from the local authority. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with 10 people who used the service and 5 relatives about their experience of the care provided. We spoke with 8 members of staff including the area manager, registered manager, deputy manager, senior care staff, cook, housekeeping and care staff. We reviewed a range of records, these included 9 people's care records and 9 people’s medication records. We looked at 2 staff records in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 21 December 2023

About the service

The Gables is a residential care home providing accommodation for persons who require personal care for up to 24 people. The service provides support to older people. At the time of our inspection there were 21 people using the service. Accommodation is split across 3 floors accessible by a lift, stair lift and stairs.

People’s experience of using this service and what we found

People told us they were happy and had their care needs met by care staff who knew them well. However, we found people had not always been provided with safe care and treatment due to a lack of robust systems and processes. This meant people had been placed at risk of harm.

Staff did not have a clear system to follow to report incidents of actual, or potential, harm. Reportable incidents had not always been referred appropriately to the local authority safeguarding team to ensure external scrutiny of the home. There was not a lessons learned process in place.

People had not always been assessed for risks to their health, safety and welfare. Staff had not always identified when a person was at risk, and this meant they had not always adopted measures to prevent the person from being harmed.

People prescribed high risk medicines such as blood thinning medicines, or sedative medicines, had not been assessed to identify any risks posed to them from taking this type of medicine. Medicines had not always been managed safely and this had put people at risk of not having medicines as prescribed.

The home was clean on the days of our inspection, however, systems to ensure people were protected from the spread of infection were not always robust. Assessments to identify people at increased risk from infections had not always been completed and checks to ensure people were safe from the spread of infection had not always been completed.

People were not always supported to have maximum choice and control of their lives and records could not demonstrate staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The home supported people living with dementia however, the adaption and design of the building did not follow best practice guidance to ensure people living with dementia could orientate themselves to their surroundings. We have made a recommendation to the home in regard to the environment for people who are living with dementia.

Governance systems were not robust. The inspection identified five breaches of regulation as systems and processes were either not in place, or not robust enough, to ensure people’s care needs were identified and people received safe care and treatment.

Staff had been recruited safely into the service and there were enough staff to meet the needs of the people living at The Gables. People and relatives were complimentary about the staff. We received comments such as, “the carers are great, they need a raise!”, “I’d recommend this home, they look after me well” and, “staff help me when I need it, I would recommend this home.”

People told us how much they enjoyed the food. People had plenty of choice and people’s dietary needs were catered for.

People, relatives, visitors and healthcare professionals spoke positively about the registered manager of the home. One relative told us, “[Registered Manager] sprinkles her love everywhere she goes.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 November 2018

Why we inspected

We received concerns in relation to the safe care and treatment of people and the governance of the home. As a result, a decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

The inspection was prompted in part by a notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls and health deterioration. This inspection examined those risks.

In response to our findings, the provider sent CQC an action plan of immediate actions they intended to make to ensure The Gables was safe for the people living at the home, we were unable to assess whether these changes have been effective and sustainable during this inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the need for consent, safe care and treatment, safeguarding people, good governance and training for staff.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.