Archived: Three Gables

Updated 17 March 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

This was an unannounced inspection by two inspectors and took place on 28 and 29 January 2016.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information we held about the home, including previous inspection reports. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

We met with people who lived at Three Gables and they told us about the care they received. We spoke with six people however, some people were unable to verbally share with us their experiences of life at the home because of their dementia needs. Therefore we spent a large amount of time during our inspection observing the interaction between staff and people and watched how people were being cared for by staff in communal areas. This helped us understand the experience of people who could not talk with us.

During the inspection we reviewed the records of the home. These included staff training records, staff files including staff recruitment, training and supervision records, medicine records complaint records , accidents and incidents, quality audits and policies and procedures along with information in regards to the upkeep of the premises.

We looked at four care plans and risk assessments along with other relevant documentation to support our findings. We also ‘pathway tracked’ people living at the home. This is when we looked at their care documentation in depth and obtained their views on their life at the home. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

During the inspection, we spoke with two relatives and seven staff members including the registered manager and a visiting healthcare professional.

Updated 17 March 2016

We carried out an unannounced comprehensive inspection at Three Gables on the 17 and 18 November 2014 where we found improvements were required in relation to the infection control, respecting people and maintaining people’s records. The provider sent us an action plan and told us they would address these issues by August 2015. We undertook an inspection on 28 and 29 January 2016 to check that the provider had made improvements and to confirm that legal requirements had been met. We found improvements had been made however not all legal requirements had been met. Some concerns with regard to record keeping and good governance identified at the inspection in November 2014 had not been sufficiently addressed.

Three Gables is a care home that provides accommodation for up to 19 older people who require a range of care and support related to living with a mental health condition. This includes a dementia type illness and behaviours that may challenge others. On the day of the inspection 18 people lived there. There is a registered manager at the home who is also one of the partners of the business. 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.

Although there were systems in place to assess the quality of the service provided in these were not always effective. They had not identified some of the shortfalls we found in relation to people’s care plans and further improvements are required to ensure they reflected all the care and support people received and required. There were shortfalls in other records which had not been identified through the audit system. For example there was no overview of training staff had received and information was missing from recruitment records. This did not impact on the care and support people received because staff knew them well.

People were looked after by staff who were kind and caring. They knew people really well and had a good understanding of people’s individual care and support needs. Staff supported people to make choices and respected their right to make decisions. People were supported by staff who treated them with dignity and respect.

There were risk assessments in place and staff had a good understanding of risks and what steps they should take to mitigate the risks. People were supported to maintain a balanced and nutritious diet. Food was freshly cooked and people were able choose what they would like to eat and drink throughout the day. Nutritional assessments were in place to identify people who may be at risk of malnutrition.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. They understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Where necessary DoLS applications and authorisations were in place.

Medicines were managed safely and staff made sure people received the medicines they required in the correct dosage at the right time. People were supported to receive appropriate healthcare to meet their needs. Healthcare professionals we spoke with were positive about the support staff provided.

There was enough staff who had been appropriately recruited to look after people. Staff were well supported by the managers and colleagues. They received regular supervision and told us they were able to talk to the registered manager at any time.

We found a breach 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 this report.