Archived: The Gables Residential Home

Updated 9 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook an unannounced focused inspection of The Gables Residential Home on 11 July 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 28 February and 2 March 2017 inspection had been made and also following concerns from other health and social care professionals. The team inspected the service against two of the five questions we ask about services: is the service safe and well led. This is because the service was not meeting some legal requirements.

This inspection was carried out by two inspectors.

Before our inspection, we reviewed information we held about the service and information we had received about the service from people who contacted us. We contacted the local authority that had funding responsibility for some of the people who used the service. We also contacted Healthwatch (the consumer champion for health and social care) to ask them for their feedback about the service.

We reviewed a range of records about people’s care and how the service was managed. This included six people’s plans of care and associated documents including risk assessments. We looked at two staff files including their recruitment and training records. We also looked at documentation about the service that was given to staff and people using the service and policies and procedures that the provider had in place. We spoke with the registered manager, one senior carer and three care staff.

We spoke with two people who used the service. This was to gather their views of the service being provided. We observed staff communicating with people who used the service and supporting them throughout the day.

Updated 9 January 2018

We inspected The Gables Residential Home on 11 July 2017. This was an unannounced focused inspection following concerns we received about the care being provided to people living in the home and in receipt of the home care service. We undertook this focused inspection to check that they had followed and met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Gables Residential Home on our website at www.cqc.org.uk.

At our last inspection on 28 February and 2 March 2017 we found two breaches of legal requirements. We took enforcement action and placed a condition on their registration. The Registered Provider must not admit any service users to the location The Gables Residential Home, without the prior written agreement of the Care Quality Commission. The term "admit" includes re-admit and this restriction should be understood to include any person who has been resident at the home at any time. The service was also placed into special measures. Following the inspection the provider was required to submit an action plan to say what they would do to meet legal requirements in relation to the breach in Good Governance and Safe care and treatment. We also requested additional information from the provider about their service. The provider failed to provide us with the information we requested.

At this inspection we found that the provider had made some of the required improvements. However, we continued to find the service was not meeting the regulations and further improvements were required. There continued to be breaches of the regulations we inspected against and safe and well led domain remained inadequate. Therefore the service remains in special measures.

The Gables Residential Home provides accommodation for people who require personal care for up to 10 people and personal care for people living in their own homes. At the time of the inspection seven people were living in the residential home and eight people were receiving care in their own home. However, one person was in hospital on the day of the inspection meaning there were only six people who were currently using the service. The home is located on two floors with a stair lift to access both floors. The home had a communal lounge and dining room. Most people who received care in their own homes lived in flats that were on the same grounds as the residential home. The same staff group worked between both the residential home and flats.

The service had a registered manager who was registered to manager both accommodation for people and personal care. 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 not protected from risks relating to their health and safety. Some assessments had been carried out but had not been reviewed when people’s needs had changed. Assessments to determine what support people needed had not been carried out since our last inspection placing people at risk of harm.

Staff could identify the potential signs of abuse and knew how to report any concerns. Where incidents had occurred that may cause concern these had not always been investigated to determine the cause. Measures had not been put in place to protect people from the likelihood of reoccurrence.

There were not enough staff deployed to keep people safe. Staffing levels had been assessed based on incorrect information. People did not have their needs assessed and it was not known how many staff were needed to meet their needs safely.

People living in the flats did not receive their medicines in a safe way or as prescribed by their GP. Medicine records had not been completed correctly.

Staff had not been recruited appropriately. Pre-employment checks had not been carried out before staff started to work at the service placing people at risk from unsuitable staff.

Equipment that people used had been checked to make sure that it was safe to use.

The provider had implemented systems and processes to monitor and improve the quality of the service that had been provided. However, these did not identify concerns that we found during this inspection.

The provider was receiving support from the local authority; however, they continued to fail by not implementing the changes being requested of them. They had not taken action following feedback from professionals to improve the delivery of the service that had been provided.

We found four 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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This could lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.”