The Gables Residential Home

Some immediate risks to people’s safety were identified and fed back to the registered manager. The front door was wedged open, and the kitchen door and side door were also open. This was addressed immediately. It was an exceptionally hot day, and no one was subject to a deprivation of liberty although a number of applications had been made. An open front door could expose people to unnecessary risk. The registered manager confirmed the door is now locked, and the registered manager confirmed they would consider how the restriction would be reviewed in line with people’s needs.

We found some radiator covers were loose or coming away from the wall, one had a hole in it. Some pipework was exposed but cool to touch. This should be risk assessed as pipework getting hot could contribute to avoidable scalding. Remedial actions were confirmed as completed by the registered manager and added to the daily health and safety audit. However, this issue had not been previously identified by the provider.

Whilst we considered the environment mostly safe, we felt it could be more personalised to suit the needs of people using the service and the rear garden more accessible. Following on from our inspection the registered manager called a resident meeting to discuss issues raised from the inspection. Further personalisation of communal rooms is being undertaken.

We found the home to be in good decorative order with no unpleasant smells or ill-fitting flooring. Falls within the service were low, as were recorded incidents. Some extensive refurbishments had been undertaken and planned within the budget.

We inspected environmental risk assessments, audits and daily walk about's. These were generally robust. Night audits were not in place, but the registered manager confirmed these are now in place.

The provider told us they ensured they had appropriate staffing levels. They said the home was fully staffed, and they rarely used agency or temporary staff and were recruiting bank staff to cover holidays etc. However, people told us they had concerns about staffing levels and staff often appeared busy and rushed. We discussed this with the registered manager as allocated staffing levels appeared generous. For example, one person told us “The staff always seem to be very busy. They help me to get washed and dressed. They don’t rush me, but they are always saying that they have another job to do.” Comments included staff not being replaced when they left and staff being under pressure at times of the day and, or weekends. We did not identify a direct impact on care, but people’s experiences were variable across the week.

We have asked the registered manager to consider the redeployment of staff and whether all staff were working effectively together. Service records, such as staff meeting minutes indicated ‘teamwork’ was an area for development and staff were being supported to work more effectively.

Throughout our observations people received unhurried care and there was the opportunity to take part in activities which were organised daily. However, on the day of our inspection a lot of people were in their bedrooms for most of the day and this included lunch time when the dining room remained empty. A few people chose to eat in the lounge. We were concerned about the risk of social isolation and why people would choose not to socialise even for some of the day. We found the environment whilst well maintained lacked stimulation. The lounge by the front door remained unused and the second lounge had day chairs in a row with a number of wheelchairs also not in use and lined up with a clear lack of storage.

Staff interacting with people did not offer to put the television on or music and activities provided were limited with no obvious support from care staff. Whilst the activity programme showed external entertainers fortnightly these were mainly the same entertainers. We spoke with the activities staff who had not had any specific training around activity provision, and we suggested to the registered manager this was necessary to help enhance activity provision. We suggested they access ‘Skills for care’ to consider additional training.

Staff received adequate training and were supported to develop and undertake additional qualifications in care and develop themselves professionally. and staff recruitment was satisfactory.

Staff felt well supported by their manager and training records and supervisions showed there were formal processes to support staff and staff were given the opportunity to give feedback on the service they provided and any improvements they would like to see. Whilst night staff were provided with the same access to support, night audits would help provide additional assurances that care provided over 24 hours was of a sufficiently high standard.

Medicines were administered in line with people’s needs and were well organised. The were two medicine trolleys which seemed excessive for the size of the home.

Staff told us people were well supported with regular access to health appointments such as chiropody and dentistry and had built good relations with the GP practice and nurses. However, we were told by visiting professionals and staff, that some people had been at the service along time and their dependency levels were increasing as their needs became greater. Whilst staff felt their training covered the basics, professionals commented on gaps in staff knowledge and the need for up-skilling staff to help them respond appropriately in identifying and acting upon changes in people's conditions.

Staff felt well supported by their manager and training records and supervisions showed there were formal processes to support staff and staff were given the opportunity to give feedback on the service they provided and any improvements they felt necessary. Whilst night staff were provided with the same access to support, night audits would help provide additional assurances that care provided over 24 hours was of a sufficiently high standard.

Infection control and standards of cleanliness were good.

The registered manager completed regular audits and reviews but had not identified some of the areas of concern we did, the provider offered valuable support but external auditing and more opportunities for the registered manager and staff to ‘network’ with other care homes may benefit the service as this was a standalone care home.

We found that staff and management worked within the principles of the Mental Capacity Act 2005 (MCA). Unnecessary restrictions were not in place. People had communication plans in place to support staff in understanding how people expressed themselves.

Deprivation of Liberty Safeguards (DoLS) authorisations were not in place or considered necessary although a number of applications had been made but not yet approved. People were not subject to unlawful or excessive restrictions they had choice, control and freedom over their lives. We advised the registered manager to consider each’ decision required in its own merit,’

The registered manager helped ensure staff were supported to reflect on their practices and incidents etc were appropriately recorded. Staff understood how to raise concerns and actions they should take if they suspected abuse. The safeguarding log did not show clearly if a notification had been raised or how it had been resolved.

About the service

The service is a care home. There were 15 people living at the service on the ground floor purpose-built accommodation. There were a number of vacant rooms, including a room on the 1st floor.

Who the service is for

The service supports older people requiring residential care.