Archived: Seven Gables

Seven Gables is a residential care home. 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. Seven Gables is registered to provide care for up to 25 people, including people living with mental health needs and dementia. At the time of the inspection, there were 12 people living at the service.

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

People told us they felt safe and cared for living at Seven Gables. We found improvements had been made and sustained, which meant people received safe care from a staff team that knew them well.

Staff had received training in safeguarding and understood their responsibilities. People were protected from abuse and there was an open culture, where staff supported people to have regular conversations where they could express any concerns.

Medicines were managed safely by trained and competent staff. Medication administration records (MARs) were fully completed and regularly audited to identify any areas for development and improvement. Staff had access to medicines policies and procedures as well as best practice guidelines.

Recruitment practices were safe and there were sufficient numbers of staff available to meet people’s needs. Quality assurance processes were robust, risks to people and the environment had been assessed and work was being carried out where action had been identified as being required. People had access to appropriate equipment where needed.

Infection, prevention and control processes and up to date policies were in place. The provider, registered manager and staff adhered to the latest government guidance in relation to infection, prevention and control.

Based on our review of safe and well led we found 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.

Staff worked well as a team and had developed positive relationships with people and knew them well. People, their relatives and external professionals told us the staff were caring and knowledgeable.

The registered manager understood their regulatory responsibilities and shared information with

stakeholders in a timely way. People, their relatives, staff and external professionals told us the registered manager was knowledgeable and supportive, which meant the home was well led.

The provider and registered manager had systems and processes to monitor safety and quality within the home and were committed to ongoing development.

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 19 January 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 30 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service between 27 August and 2 September 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, risk management, staffing, recruitment, dignity and governance.

We undertook this focused 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 and Well-led which contain those requirements.

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.

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 Inadequate to Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Seven Gables is a residential care home. 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. Seven Gables is registered to provide care for up to 25 people, including people living with mental health needs and dementia. At the time of the inspection, there were 21 people living at the service.

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

Although people told us they felt safe, we found that people did not receive a service that ensured they were safe. Risks were not always assessed, identified and managed to meet people's needs. Care plans and risk assessments did not identify essential information to ensure people were supported in a safe way. There was a lack of provider oversight to address risks to people. Staff lacked knowledge in what their responsibilities were under safeguarding processes and as a result people were exposed to continuous risk of harm.

Medicines were not managed safely. Bathrooms and people’s bedrooms were not clean, which meant there were infection control risks. Staff did not use safe practices when using personal protective equipment. Staffing levels were not sufficient to ensure people were safe and received good care. There had been a high level of staff resignations within a short timeframe. Recruitment processes were not robust which put people at risk of being supported by unsuitable staff.

People were not always shown respect and dignity when being supported by staff and there was a lack of meaningful activities that people would enjoy.

People were not supported to have maximum choice and control of their lives and staff did not always 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.

The leadership of the service was impacted by the absence of management oversight or contingency planning. The provider oversight of the service had been poor. There was insufficient risk management and quality monitoring. Auditing was not robust and there were missed opportunities for learning and improving the quality of care.

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 26 February 2019).

Why we inspected

We received concerns in relation to staffing levels, medicines management, food safety, accident and incident management and people’s safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care services 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.

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

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Seven Gables 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 keeping people safe, risk management, medicines, staffing numbers, staff recruitment, dignity and respect, leadership and oversight of the service at this inspection.

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

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.

Seven Gables is a residential care home. 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. Seven Gables is registered to provide care for up to 25 people, including people living with mental health needs and dementia. At the time of the inspection, there were 25 people living at the service.

People’s experience of using this service:

• The environment was warm and homely. Communal areas of the home had recently been re-decorated.

• People told us they were happy living at Seven Gables. There was an established staff team that knew people well. One person told us, “I’m quite happy here.”

• Individual and environmental risks were managed appropriately. People had access to appropriate equipment where needed, which meant people were safe from harm.

• Medicines were administered safely and as prescribed. This was monitored through an electronic medicine administration system.

• Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

• Staff recognised people’s individual needs and supported them to make choices in line with legislation.

• People and their families were involved in the development of personalised care plans that were reviewed regularly.

• The registered manager and provider carried out regular checks on the quality and safety

of the service.

• The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection:

The service was rated as Good at the last full comprehensive inspection, the report for which was published on 26 July 2016.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

There is no required follow up to this inspection. However, we will continue to monitor the service and will inspect the service again based on the information we receive.

There was a registered manager at the home. 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.

Medicines were managed safely and people received these as prescribed. People and external health professionals were positive about the service people received. People were positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people were conducted regularly.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Staff worked well together, which created a relaxed and happy atmosphere, that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

The registered manager and provider were aware of key strengths and areas for development of the service.

Quality assurance systems were in place using formal audits and regular contact by the provider and registered manager with people, relatives and staff.

We also spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. The staff knew what care and support people needed and they respected their wishes. We viewed three care plans. The care we observed generally corresponded with care plans.

We found sufficient staff were available and people received a varied diet with a choice at each meal. The environment was suitable for people and well maintained. Appropriate equipment was provided. All necessary records were held and these were stored securely.

We spoke with one health professional and one social care professional involved in the care of people. They were complimentary about the way the service met people's needs. We were told that they were contacted appropriately and staff followed any guidance and suggestions.

We observed that staff were courteous and respectful of people's views and opinions and that dignity was respected. We also observed that appropriate moving and handling assistance was provided. We spoke with three staff and looked at recruitment procedures which were appropriate and included all the necessary pre-employment checks. Although medication was stored and administered correctly there had been a short delay in obtaining medication for one person.