CQC report explained · a residential care home
What the CQC found at Four Gables
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Risks were assessed and plans were in place to reduce them. Inspectors found safe staffing, recruitment checks, infection control and medicines procedures.
- Effective?
- Good
- Staff had relevant training and support. People received suitable food, healthcare and support with communication and decision-making.
- Caring?
- Good
- Staff treated people warmly and respectfully. People were involved in decisions, supported to maintain relationships and given privacy.
- Responsive?
- Good
- Care plans were detailed and regularly reviewed. Activities and communication were adapted to people's preferences and needs, and complaints were recorded and handled.
- Well-led?
- Good
- The service had an approachable management team and systems for checking quality and making improvements. This rating improved from Requires Improvement at the previous inspection.
What inspectors found, July 2019
People in Action - Four Gables is rated Good in all five areas; inspectors found kind, person-centred care and improved leadership.
The CQC carried out a planned inspection on 11 June 2019. One inspector visited the home, which had five people living there. The inspection was announced 24 hours in advance.
Inspectors spoke with two people, staff, managers and two relatives. They observed care and checked care plans, medicines records, accident records, complaints, audits and other management records. Some people could not give feedback because of their complex care needs and disabilities.
The home was rated Good overall and Good in Safe, Effective, Caring, Responsive and Well-led. Inspectors found people were treated with kindness and dignity, had choice in their daily lives, and received personalised support. The Well-led rating improved from Requires Improvement at the previous comprehensive inspection in November 2016 to Good.
Personalised support
Care was planned around each person's needs, preferences, routines and communication. People and their families were involved in preparing and reviewing care.
“People and their relatives were placed at the heart of the service and were involved in choosing their care and support, from pre-admission to living in the home.” from the report
Kind and respectful care
Inspectors saw staff communicate warmly and protect people's dignity, privacy and independence.
“Staff communicated with people in a warm and friendly manner.” from the report
Activities and choice
People could choose how to spend their time, and activities were based on their interests and preferences.
“Activities took place with individuals, based on their personal preferences, each day.” from the report
Safety arrangements
The home assessed risks, maintained equipment and had emergency plans for each person. Medicines and infection control were managed safely.
“Risks to people were assessed and mitigation plans were in place to reduce risks.” from the report
Improved leadership
The management team used audits, feedback and action plans to monitor care and make improvements. The Well-led rating improved from Requires Improvement to Good.
“At this inspection this key question has now improved to Good.” from the report
Inspectors raised no specific concerns in this report.
- 01How will you adapt my relative's care plan and communication methods to their particular disability or communication needs?
- 02How are risk assessments, support plans and best-interest decisions reviewed and updated?
- 03What staffing level and staff skills would be available for my relative's assessed needs?
- 04How would you support my relative to take part in activities, go out and maintain family relationships?
- 05How do you record and act on medicines errors, incidents or complaints?
This was a planned inspection covering the overall quality of the care home and all five CQC questions; the previous inspection was in November 2016. This explanation was written from the published report of 23 July 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2016
People in Action - Four Gables was rated Good overall, with kind and personalised care but Requires Improvement for well-led.
The inspection was announced and took place on 29 September 2016. One inspector reviewed records, medicines information, staff recruitment records, complaints and quality checks. They also observed care, spoke with four staff and the manager, and spoke with three relatives by telephone.
The home supported five people with complex needs. Inspectors found people were safe, received medicines as prescribed and had enough staff support. Staff were trained, caring and respectful. People were supported to make choices, stay independent, see health professionals and take part in activities.
The main weakness was management checking. Some care plans and health records were out of date. Some risk assessments were missing, and health professionals' guidance was not always followed consistently. The manager took action shortly after the inspection to address the issues found.
The overall rating was Good. Safe, effective, caring and responsive were all rated Good. Well-led was rated Requires Improvement because the systems used to check quality and safety had not always found important gaps.
Safe medicines support
Staff were trained and checked as competent to give medicines. Records showed medicines were given as prescribed, and audits were used to investigate errors.
“People received their medicines safely and as prescribed from trained and competent staff.” from the report
Kind, respectful care
Inspectors saw staff building positive relationships and responding to people's non-verbal communication. People were supported with dignity, choices and independence.
“People were treated as individuals and were supported with kindness, dignity and respect.” from the report
Personalised support
Care plans included people's likes, dislikes, histories and preferred ways of receiving support. People were helped to maintain hobbies, family relationships and activities.
“People received personalised care and support which had been planned with their involvement” from the report
Enough staff
Inspectors saw enough staff to support people with appointments, groups and activities. The manager used agency staff with experienced workers when needed.
“There were enough staff to meet people's needs.” from the report
Missing risk assessments
seriousSome identified risks did not have a corresponding written assessment. This could make it harder for staff to know what to monitor and when to seek medical advice.
“However, there were not always risk assessments in place where risk had been identified.” from the report
Health guidance not always followed
seriousStaff did not always follow specialist dietary guidance consistently. The manager arranged a new assessment and updated risk information after the inspection.
“when staff explained how they managed this risk, we found they did not always follow these guidelines consistently.” from the report
Out-of-date care records
needs fixingSome care plan reviews were overdue, and some health passports and health action plans were incomplete. The manager said these records would be reviewed and updated.
“Care plans had not always been reviewed according to the provider's policy and procedure.” from the report
Quality checks missed gaps
seriousThe home's checking systems did not always identify problems with risk assessments, care plan reviews and health records. Inspectors said this meant some people were at risk of a deterioration in their health.
“This meant some people were at risk of a deterioration in their health, and the provider had not ensured they were kept safe through quality checking.” from the report
Privacy incident
minorOne personal care task was attempted in a communal area rather than a private space. The manager addressed this with the staff member and the wider team.
“we observed another staff member attempting to support a person with a personal care task in a communal area of the home, instead of assisting the person to a private area.” from the report
- 01How are risk assessments now checked to make sure every identified health and safety risk has clear guidance for staff?
- 02How do you make sure specialist dietary guidance is followed consistently at every meal?
- 03How often are care plans, health passports and health action plans reviewed, and who checks that reviews are not overdue?
- 04What quality checks are now in place to make sure important gaps are found quickly?
- 05How will the home protect people's privacy during personal care, including when communal areas are busy?
This was an announced inspection of the overall service and all five CQC questions, including observations, discussions with relatives and staff, and reviews of care and management records. This explanation was written from the published report of 9 November 2016 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Four Gables
2 rated inspections over 3 years: the service has held its Good rating throughout.
- July 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- April 2011
Registered with the Care Quality Commission on 7 April 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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