CQC report explained · a residential care home
What the CQC found at The Gables
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found problems with COVID-19 testing evidence, infection care plans, PPE, safeguarding processes and proof of staff DBS checks. They also found enough staff on duty and safe arrangements for medicines, risks and seizure support.
- Effective?
- Requires improvement
- Does the care work? Training, consent, food and drink, working with GPs and nurses.
- Caring?
- Good
- Are people treated with kindness and dignity?
- Responsive?
- Good
- Is care built around the person? Care plans, activities, complaints.
- Well-led?
- Requires improvement
- The provider's quality checks did not identify important problems, including gaps in cleaning records, missing capacity decisions and delays in COVID-19 care planning. Communication and cooperation with CQC and other agencies were also not effective.
What inspectors found, August 2021
Rated Requires Improvement; inspectors found risks around infection control, safeguarding and management oversight, although some action was taken after the inspection.
This was a focused inspection of safe and well-led care. Inspectors visited on 22 December 2020 and 7 January 2021, spoke with people, a relative, staff and professionals, and checked care, medicines and management records.
The home did not provide some information inspectors requested. At the time, there were concerns about COVID-19 testing, care planning, unsuitable masks, safeguarding processes, staff checks and capacity assessments. The provider later supplied evidence of some improvements, including regular testing, correct PPE and DBS checks.
People received their prescribed medicines and there were enough staff on duty. Staff and relatives gave positive feedback about the caring and friendly approach of staff. However, the home's systems did not reliably identify or deal with risks, and the provider did not work openly and promptly with external agencies.
The overall rating remains Requires Improvement. Safe fell from Good to Requires Improvement, while well-led remained Requires Improvement. The home has had this overall rating for the last two consecutive inspections.
Staffing
Inspectors saw an established staff team and found enough staff on duty to meet people's assessed needs.
“There was an established staff team in place, we saw there were enough staff on duty to ensure people were supported according to their assessed need.” from the report
Staff training
Staff had safeguarding refresher training, and the provider encouraged staff to develop their skills.
“The registered provider had accessed professional development resources and actively encouraged staff to improve their skills.” from the report
Risk records
The home had systems to record accidents and incidents, and inspectors saw regularly reviewed risk assessments. There was also guidance for supporting a person during seizures.
“Systems and processes were in place to assess risk relating to people's health and safety, we could see that risk assessments were regularly reviewed.” from the report
Infection control
seriousAt the inspection, the provider could not show a regular COVID-19 testing programme or adequate COVID-19 care plans. Staff were also wearing masks that had been identified as unsuitable. The provider later showed evidence of improvements.
“Staff were not wearing appropriate Personal Protective Equipment (PPE). The masks being worn by staff had been identified as not fit for purpose by the Health and Safety Executive board and a safety alert had been issued.” from the report
Safeguarding
seriousInspectors found that the provider did not always follow its safeguarding policy or share information with local safeguarding systems accurately and promptly. This increased risks to people's safety and welfare.
“The provider failed to follow their own safeguarding policy and engage with local safeguarding systems.” from the report
Staff checks
seriousThe provider did not initially provide staff files or demonstrate that all staff were suitable to work with vulnerable people. Evidence of relevant DBS checks was supplied after the inspection.
“The provider failed to demonstrate they were assured staff were suitable to work with vulnerable people.” from the report
Management oversight
seriousQuality checks did not identify several problems, including missing cleaning records, missing best-interest decisions and delays in COVID-19 care planning. The provider also delayed giving information to inspectors and other agencies.
“The provider had failed to effectively monitor and improve the quality of the service, and to monitor and mitigate risks to people's safety.” from the report
Mental capacity decisions
needs fixingBest-interest decisions were not always recorded, and further work was needed to assess people's capacity for specific decisions.
“There were a lack of best interests decisions in place.” from the report
- 01What evidence can you show that regular COVID-19 testing and correct PPE are now in place?
- 02How are safeguarding concerns reported to and followed up with the local authority?
- 03How do you check that all staff have the required DBS checks before working with residents?
- 04How are mental capacity assessments and best-interest decisions recorded and reviewed?
- 05How does the current quality assurance system identify problems such as missed cleaning records and incomplete care plans?
This was a focused inspection of Safe and Well-led only; the other key question ratings were carried over from previous comprehensive inspections. This explanation was written from the published report of 5 August 2021 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, May 2019
The Gables was rated Requires Improvement overall; inspectors found safe, kind and responsive care, but improvements were needed in effectiveness and leadership.
This was a planned, announced inspection on 9 April 2019. One inspector visited the home, spoke with the two people living there, staff, relatives and an external health professional, and checked care records, staffing, training and management information.
The home was rated Good for Safe, Caring and Responsive. Inspectors found enough staff, suitable risk assessments, safe medicines support, kind interactions and personalised care. People were supported with food, healthcare, activities, independence and their choices.
The home was rated Requires Improvement for Effective and Well-led. Records did not always explain how important care decisions had been agreed. The home also needed clearer audits and better communication with external professionals and the CQC. The overall rating was Requires Improvement, compared with Good at the previous inspection.
People were kept safe
Staff understood how to recognise and report abuse. Risk assessments were in place and reviewed when people's risks changed.
“Staff had received safeguarding refresher training and demonstrated a clear understanding of how to identify if a person may be at risk of harm or abuse and how to report their concerns.” from the report
Kind and respectful support
Staff understood people's communication methods and supported their interests, choices, privacy and independence.
“Staff demonstrated they knew people well and that they understood and were able to use the communication methods each person preferred.” from the report
Personalised care
Care records described what mattered to people and how they wanted support to be provided. People were helped to remain independent with everyday activities.
“Care records were personalised and included details about what was important to people and how they wanted their support to be provided.” from the report
Support for health and nutrition
People had access to suitable food and drinks and were supported to use health services. Staff worked with health professionals when needed.
“People continued to have access to the food and drinks they needed to stay healthy and they were supported by staff to plan their menus and to buy the food they wanted in line with their choices.” from the report
Care decisions were not always recorded clearly
needs fixingRecords did not explain how the decision to use a wheelchair and safety strap had been made, or whether the person had capacity to consent to this arrangement. The provider said it would review the arrangements.
“However, there was no information to show how the decision had been made or that the person had capacity to consent to the chair and the safety strap being used if needed.” from the report
Management checks were not clearly recorded
needs fixingThe provider carried out checks but did not have a formal system that clearly recorded the audits completed. This meant the provider could not clearly demonstrate how the home was learning and improving.
“However, a more formal system of maintaining clear information about the audits completed was not in place.” from the report
Communication with outside professionals needed improvement
needs fixingThe home was slow to provide some information to the CQC and had not proactively shared responses to commissioners' recommendations and reviews.
“We also found the registered provider had not been pro-active in communicating responses to local authority commissioning visit recommendations and the outcome of reviews and actions they were taking to keep commissioners fully updated regarding the on-going delivery of care.” from the report
More varied activities were needed
minorPeople took part in activities, but there was limited evidence of a sufficiently varied range of individual, person-centred and communal activities. The provider agreed to explore new options.
“However, there was limited evidence that there was a varied enough range of individual, person centred and communal activities for people to take part in.” from the report
- 01What changes have you made to record how decisions about wheelchairs, safety straps and other equipment are agreed?
- 02How do you check and record the quality audits you complete, and how do you act on any issues found?
- 03How do you now communicate recommendations and actions with commissioners, health professionals and the CQC?
- 04What new individual and communal activities have been introduced since the inspection?
- 05How are people and their relatives involved in reviewing care plans and decisions about support?
This planned inspection looked at all five CQC question areas and the care provided to the two people living at the home; no one was using the separate service providing support in people's own homes. This explanation was written from the published report of 15 May 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.
Every inspection of The Gables
3 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- August 2021Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2019Requires improvementdown from GoodSafe: GoodWell-led: Requires improvement
- January 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2013
Report published without a new overall rating.
- October 2012
Report published without a new overall rating.
- May 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 24 December 2010.
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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9 live-in carers within about an hour of Lincolnshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
8 can care for a couple. 10 years' experience on average.
“Martin was more than a carer, he managed the home and became my uncle's best friend, enriching his life during his last few years.”
“Magda was always positive and proactive about trying new things to keep dad busy. She also introduced new ideas for keeping dad healthy.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.