Archived: Five Gables Nursing Home

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.

Five Gables Nursing Home is a care home registered to provide personal and nursing care for up to 43 older people. At the time of the inspection there were 22 people residing at the service.

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

Systems and processes to ensure oversight of the service required improvement. Governance systems were not effective in identifying the concerns we found on inspection and quality assurance systems were ineffective in identifying when tasks had not been completed or recorded.

The environment was not always safe. We found people had access to harmful substances.

Infection prevention and control procedures required improvement. Cleaning schedules were not always completed, and COVID-19 measures were not consistently followed.

Medicine management procedures were not always followed. Medicine records were not consistently completed appropriately and not all documentation was in place.

Care plans and risk assessments did not always contain sufficient information to ensure safe care could be completed. Staff did not always have the required information available to them. Risks to people had not always been recorded or mitigated. Risk assessments were not consistently in place and strategies were not always recorded as completed.

Injuries were recorded and relatives were kept up to date. When a person had an unexplained injury, an investigation into the cause had been completed.

People were supported by kind staff who had been recruited safely. Staff training required updating to ensure staff had the skills and knowledge to support people safely.

People were supported to access healthcare, and the provider made referrals to health professionals as required.

People were 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 supported this practice.

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 28 July 2021) and there were five breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed from Inadequate. This is based on the findings at this 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Five Gables Nursing Home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to records, risk assessments and care plans, medicines, infection control, oversight and the environment 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 of 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.

Five Gables Nursing Home is a care home registered to provide personal and nursing care for up to 43 older people. At the time of the inspection there were 28 people residing at the service.

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

Quality systems were not effective in identifying when care and support was not up to standard.

Systems and processes to ensure oversight of the service required improvement. Audits had not been completed regularly and the issues found on inspection had not been previously identified by the provider.

Risk assessments were not consistently in place. Mitigating strategies had not always been identified to ensure people were kept safe from harm.

Records of care tasks and health tasks had not been consistently completed. We could not be assured that people’s holistic needs were being met.

Injuries were not always recorded. When a person had an unexplained injury, it had not always been investigated to identify a cause.

The environment was not always safe. We found a blocked fire exit, access to harmful substances, unclean areas and out of date food.

Medicine management was not always safe. Medicines were not always kept securely; medicine records were not consistently completed appropriately and not all documentation was in place.

Care plans did not always contain sufficient information to ensure safe care could be completed. Staff did not always have the required information available to them.

Peoples nutrition and hydration needs were not always adequately recorded.

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

People were supported by sufficient staff, who had been safety recruited and had received training. People stated that staff were kind and respected their privacy.

People, staff and relative knew how to complain and felt any concerns would be listened to and resolved.

Feedback was sought from people, their relatives and staff. The last survey’s completed in October 2020 were positive.

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 requires improvement (published 21 November 2020) and there were two breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made or sustained and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to training, medicine management, safeguarding and oversight. As a result, we undertook a full comprehensive inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, consent, oversight, safe care and medicines 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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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.

Five Gables Nursing Home is a nursing home providing personal and nursing care to people 35 people at the time of the inspection. The service can support up to 43 people.

The service is delivered across two separate buildings. Each building has a communal dining room and lounge with access to a shared garden.

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

Risks to people and risks in the environment were not consistently well managed to ensure people were safe and medicines were not consistently managed safely.

Infection control including cleaning and food hygiene required improvement to ensure risks were further mitigated. We are somewhat assured that the service can respond to coronavirus and other infection outbreaks effectively. We have provided guidance to the registered manager to develop their approach in supporting people to stay in contact with their family and ensuring risks for vulnerable people and staff are thoroughly assessed.

We have made a recommendation that staffing numbers are reviewed to ensure there are enough staff to meet people’s needs, keep people safe and support them in an emergency.

The registered manager had not fully understood their responsibilities in ensuring ensure people’s safety and maintaining a safe environment, this would require further learning, development and support. Systems and processes to monitor the safety and quality of the service were not consistently effective and had not highlighted concerns we found during the inspection.

Staff were recruited safely with appropriate checks in place. People were protected from the risk of abuse by staff who were trained and knew how to raise concerns.

Care plans reflected people’s likes, dislikes cultural and religious needs were supported. Relatives and people were considered partners in their care and were listened to and kept informed. People had been supported to stay in touch with family as much as possible throughout the Covid 19 pandemic.

The registered manager and staff team liaised with health care professionals appropriately to ensure people’s needs were met.

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 11 September 2018)

Why we inspected

The inspection was prompted in part due to concerns received about care of people, staffing numbers and medicines management. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Five Gables Nursing Home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety and managerial oversight of safety at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, in June 2017, the service was rated as 'Requires Improvement' although there were no breaches in regulations.

When we inspected in June 2017 we found that improvements were required under four out the five questions we always ask about safety, effectiveness, caring, responsiveness, and well-led. The provider and registered manager had taken timely and appropriate action at the time of the previous inspection but we needed to be assured that these improvements had been sustained.

At this inspection on 25 and 26 July 2018 we saw that all the required improvements that had been made had been sustained. At this inspection we found the service to be rated as 'Good'.

Five Gables Nursing Home is registered to residential care for up to 43 people who require support with personal care and nursing care. At the time of this inspection there were 29 people living in the home.

There was 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.

The service met all relevant fundamental standards related to staff recruitment, training and the care people received. People’s care was regularly reviewed with them so they received the timely support they needed. Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation.

People were cared for by staff that knew what was expected of them and the staff carried out their duties effectively. The staff team were appropriately deployed throughout the home to ensure people's needs were met in a timely way. Staff were friendly, kind and compassionate. They had insight into people’s capabilities and aspirations as well as their dependencies and need for support. They respected people's diverse individual preferences for the way they liked to receive their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received their medicines in a timely way. People were provided with a nutritious diet that took into account their tastes and preferences. Their dietary needs were assessed and monitored and appropriate external healthcare professionals, such as the dietician, were consulted when needed. Where people needed physical assistance to eat and drink this was provided.

People at the end of their life received the care they needed to ensure they were kept free of pain and discomfort.

The provider and registered manager led staff by example and enabled the staff team to deliver individualised care that consistently achieved good outcomes for all people using the service.

The service worked in partnership with other agencies to ensure the quality of care was sustained across all levels. Communication was open and honest, and any improvements identified were worked upon as required. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong so that the quality of care across the service was improved.

People, relatives and staff were encouraged to provide feedback about the service and this was used to drive continuous improvement. The provider had quality assurance systems in place that were used to review all aspects of the service and drive improvements whenever needed.

People knew how to complain and were confident that if they had concerns these issues would be dealt with in a timely way.

Five Gables Nursing Home is registered to residential care for up to 43 people who require support with personal care and nursing care. At the time of this inspection there were 36 people living in the home. At the last inspection, in June 2015, the service was rated Good. At this inspection we found the service to be rated as Requires Improvement.

There was a registered manager in post at the time of our inspection. 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 in place to assess, monitor and improve the quality and safety of the service were not always effective at identifying shortfalls. Where shortfalls were identified these were not always addressed in a sufficiently timely manner. People were not always protected from the risk of infection as some areas of the home were not sufficiently clean or maintained.

People did not always receive their care from sufficient numbers of staff and people felt that there was not enough social stimulation and activity available. Some people were left waiting for support to have their food and drink and people's nutritional risk assessments were not always accurate; although staff were aware of people’s nutritional needs and had accessed extra support as needed.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received training in areas that enabled them to understand and meet the care needs of each person.

People felt safe in the home and relatives said they had no concerns about people’s safety. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed; relevant health care professionals were appropriately involved in people’s care.

People developed positive relationships with the staff, who were caring and treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage complaints.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The service had a positive ethos and an open culture. People, their relatives and staff told us that the registered manager was a visible role model in the home. There were opportunities for people and staff to contribute to the running of the home.

One member of staff told us, 'It is a new career for me, I really enjoy it.'

Family members who visited their relatives at the home told us they were happy with the care and support provided. One person told us, "X is doing well here. If there are any problems I just talk them and it is sorted."

Another relative we spoke with told us, 'I am really pleased with how X has settled, the carers do reallly care about the people."

As part of our inspection we looked at how the provider managed the information and records of the people who lived at the home. Overall we found that the provider had appropriate measures in place to keep informaiton records up-to-date and to make sure that information was kept securely.