Background to this inspection
Updated
10 August 2022
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 completed by two inspectors.
Service and service type
Five Gables Nursing Home 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. Five Gables Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with eight people who used the service and four relatives about their experience of the care provided. We spoke with eight members of staff including two directors, the manager, nurses, and care workers
We reviewed a range of records. This included 10 people’s care records and multiple medication records. We looked at three staff files 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
10 August 2022
About the service
Five Gables Nursing Home is a residential care home providing personal and nursing care for to up to 43 older people. At the time of our inspection there were 21 people using the service.
People’s experience of using this service and what we found
Systems and processes to ensure oversight were not always effective. Audits completed had not identified and rectified the concerns found with record keeping, missing information, medicine administration and water temperatures.
Care plans and risk assessments did not always contain factual up to date information. People with specific health needs did not always have the information recorded to support staff to safely support them.
Risks had not always been mitigated and records did not evidence care was completed in line with people’s needs. Risk strategies had not always been implemented or followed.
Records of staff completing care tasks were not consistent. We found gaps in personal care records, oral care and food records.
Person centred care required improvement. Some bedrooms were bare, people and relatives told us staff did not always know the people they supported and information on individual preferences had not always been recorded.
Medicine management required improvement. Records were not always completed, and staff did not always have the required information to understand and ensure people received their medicines as prescribed.
Not all staff had the training required to understand and have the knowledge of people’s individual needs.
People were mostly supported to have maximum choice and control of their lives and 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. Mental Capacity assessments required improvement.
People and relatives did not always feel that all staff were kind and caring. We received mixed views from both people and relatives.
The environment had improved, and the provider had a plan in place to continue to update and redecorate the service. Safety mechanisms were in place. For example, window restrictors, radiator and hot pipe covers.
Referrals were made to external professionals to meet people’s needs. For example, to speech and language therapists, Falls team and dieticians.
Relationships were supported and families were made to feel welcome when visiting the home.
Complaints were managed effectively. People, relatives and staff all told us they felt comfortable raising concerns.
Feedback was requested from people, relatives and staff. Meetings were arranged to share and discuss information.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 23 March 2022) and there were breaches of regulation. The provider completed action plans after the last inspection to show what they would do and by when to improve. At this inspection we found not all improvements had been made and the provider was still in breach of regulations.
The service remains rated inadequate. This service has been rated inadequate for the last three consecutive inspections.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to records, risk mitigation, oversight, person centred care and medicine management at this inspection.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service remains 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.