Archived: The Gables

Updated 4 May 2017

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.

The visit was undertaken by two inspectors, a specialist pharmacy inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

As part of the inspection we looked at the information we had about this provider. Providers are required to notify the Care Quality Commission [CQC]about specific events and incidents that occur including serious injuries to people receiving care and any safeguarding matters. Appropriate notifications had been sent by the registered provider. We also spoke with service commissioners (who purchase care and support from this service on behalf of people who live in this home) to obtain their views. The registered provider produced an action plan after our last inspection. They had updated and shared this with us regularly since our last inspection. All this information was used to plan what areas we were going to focus on during the inspection.

During our inspection we spoke with eleven people who used the service and six relatives. We spoke with the person in day to day charge of the home, the regional manager, deputy manager, care, maintenance staff and housekeeping staff. We completed a SOFI (Short observational tool for inspection). SOFI is a way of recording the experiences of people who may not be able to talk with us.

We sampled some records including parts of four people’s care plans to see if people were receiving their care as planned. We sampled records maintained by the service about quality assurance. A member of the CQC medicines team reviewed the management of medicines, including the Medicine Administration Record (MAR) charts for eight people.

Updated 4 May 2017

We carried out this unannounced inspection on the 22 March 2017. The Gables provides nursing care and support for up to 51 older people who may also dementia. At the time of our inspection 32 people were residing at the home. The home is divided into two separate units; one on the ground floor and one on the first floor of the home.

We undertook a comprehensive inspection of this home in December 2016 when we identified that improvements were needed throughout the service. We judged the home to require improvements in all five of the key questions we inspect. [Is the service safe, effective, caring, responsive and well led?] The registered provider had breached two of the legal regulations. This was because the systems in place to monitor the safety and quality of the service had not been effective, and medicines were not being safely managed or given as prescribed. We issued warning notices in regard to these two legal breaches. Warning notices are one of our enforcement powers.

We undertook this focused inspection to check and to confirm that they now met 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) on our website at www.cqc.org.uk.

This inspection was planned and undertaken to look at the key questions of safe and well-led, to check that the action required in the warning notices had been taken, and to provide assurance that people using this service were now safe and receiving a good quality service. This most recent inspection identified that the requirements of the warning notices had been met in full, and although some further improvements were required or continued to need time to be fully operational within the home, people could be more confident that their needs would be met and their safety maintained. We received positive feedback about the difference this had made to people's quality of life and safety.

The home had a registered manager who was unable to be present at 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. The registered provider had arranged for another member of their staff to be in day to day control of the home.

Improvements had been made to the management of medicines. Improvements continued to be required however people could have greater confidence that they would be given their medicines safely, as prescribed and have assurance that the systems in place to monitor medicines were more robust.

People told us that they felt safe. People told us that they had greater confidence in the staff who were supporting them. Staff we spoke with had knowledge of possible signs of abuse and could describe action they would take in reporting any concerns.

Action had been taken to improve the number of staff available. Most people told us there were adequate numbers of people to support them and that they did not have to wait unreasonable amounts of time for help. Some further work was required to ensure the staff were available when people required support. Newly recruited staff that we met in December 2016 had settled into their role, and got to know people well. Staff told us they had received training and on-going support. We observed staff working safely.

We looked at risks people were exposed to that were related to their health care needs and lifestyle choices. These had been assessed using professionally recognised tools, and for most people had been kept up to date. Some people's records had not been fully completed, and our observations and feedback suggested that they had not always had these care needs well met.

Everyone told us that the new management team had made a positive impact on the quality of care, environment and atmosphere of the home. People, their relatives and staff told us they felt able to approach the management team with concerns or feedback, and people told us they were enjoying the more comfortable and homely environment. Previous inspections and the local infection prevention team had raised concerns about the cleanliness of the home. We found that improvements had been made to the cleanliness of the home, although work continued to be necessary to ensure people enjoyed a consistently clean environment and that the registered provider fully complied with infection control requirements. People had been supported to provide feedback about of their experience of using the service, this had been used to improve their care and life experiences.

The systems in place to monitor the quality and safety of the service had been some what effective. The management team and systems in place had driven improvement, ensured changes were embedded. They monitored the feedback and progress with people who lived, worked or visited the service. The inspection identified some further issues relating to safe care, people's meal time experience and medicines management that required attention. While these did need to be addressed to ensure people’s needs were well met, the issues identified would not have had such a significant impact on people's safety or comfort as we had found in previous inspections. People could have greater confidence that they would receive a good, safe service that would meet their needs and wishes.