Gabriel Court Limited

Gabriel Court Limited is a residential care home without nursing, providing personal care for up to 44 older people, including those living with dementia and mental health needs. At the time of the inspection 36 people were being supported.

Gabriel Court has accommodation across two floors, in one adapted building (Bluebell unit) and one purpose-built building (Foxglove unit).

People’s experience of using this service and what we found

We observed there were insufficient staff to meet people’s needs safely, particularly in the Bluebell Lounge which was the high dependency unit.

The registered manager had left, and the provider had recruited an interim manager swiftly to ensure the smooth running of the service. They were being supported by the operations manager to continue to drive improvement at the service. Recruitment for a new permanent manager was taking place at the time of our inspection.

Improvements had been made to the systems for safe medication administration. However, further information was required to ensure the PRN protocols guided staff to administer ‘as required’ medicines safely and consistently.

The provider's quality assurance systems and processes had been overhauled and improved to ensure they were more effective. This meant the managers and the provider had better oversight of the service. Many of these systems were newly implemented and needed time to become embedded into staff practice so they could be assessed for their effectiveness. Not all systems in place had been effective and had failed to identify staff deployment issues.

Improvements had been made to the fabric of the building to ensure it was conducive to effective cleaning. We saw flooring had been replaced and areas repainted, so they were more easily cleanable. The environment had been improved to ensure it was safe for people.

Staff understood safeguarding procedures and were confident in reporting any concerns. Risks to people's safety were assessed and well managed, and people’s care plans detailed current risks and individual needs.

Staff were appropriately recruited to ensure people were suitable to work at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People's care needs were assessed before they went to live at the service, to ensure their needs could be fully met. Staff received an induction when they first commenced work at the service, and we found improvements had been made to staff training to ensure they had the skills and knowledge to provide effective care.

People were supported to eat and drink enough and staff supported people to live healthier lives and access healthcare services.

Staff felt well supported and said the management team were open and approachable. The service worked in partnership with outside agencies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 15 November 2022) and there were 3 breaches of registration in relation to Safe care and treatment; Adapting service, design, decoration to meet people’s needs and Good Governance. Continued conditions were applied to the provider's registration. This service has been rated requires improvement for the last 4 consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of 2 regulations but remained in breach of regulation 17 Good Governance. We also found a breach of Regulation 18 Staffing, at this inspection.

Why we inspected

We undertook this focused inspection to check that the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified 1 continued breach of regulation in relation to Good Governance and a new breach of regulation in relation to staffing at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Gabriel Court Limited is a residential care home without nursing, providing personal care for up to 44 older people, including those living with dementia and mental health needs. At the time of the inspection 41 people were being supported.

Gabriel Court has accommodation across two floors, in one adapted building (Bluebell unit) and one purpose-built building (Foxglove unit).

People’s experience of using this service and what we found

People were at risk of infection because the fabric of the building was aged and not conducive to effective cleaning. For example, flooring in some toilets were not sealed, many carpets were dirty and stained and there were malodours in some bedrooms. Skirting boards were chipped and the paint was peeling off, some walls had areas of plaster exposed which meant these areas could not be cleaned effectively.

The premises had not been decorated and maintained to ensure a safe environment that met service user’s needs. Many areas of the service were in a state of disrepair and numerous bedrooms needed to be redecorated and flooring replaced. Communal toilets were in need of redecoration and required new flooring. The outside garden area was not safe or secure for people to use. We saw a small walkway that led off from the garden and was accessible to people. There were roof tiles, gas bottles, concrete slabs, bricks and fencing panels stored in the walkway posing a risk to peoples safety.

Although improvements had been made to the quality assurance systems since the last inspection in May 2021 it was not robust enough to be effective in all key areas and did not ensure the provider had sufficient oversight. Environmental and infection control audits were not completed regularly to ensure the provider could identify and drive improvements at the service.

There were no effective monitoring checks of all essential equipment used at the service to ensure they were working safely, and action taken if they weren’t. For example, we found four, bed pressure mattress units showing a fault and the fire alarm had been showing a fault since July 2022.

Some improvements had been made to staff training since the last inspection, but there remained gaps in some areas. For example, safeguarding, moving and handling and infection control.

Improvements had been made to ensure people received sufficient nutrition and hydration and that any weight loss was swiftly addressed with a relevant health professional. Nutrition and hydration audits were in place and completed monthly by the registered manager.

Following the last inspection, the provider had employed the services of a consultantancy company to support the registered and deputy manager with care planning and records management. We found robust improvements had been made to care plans, risk assessment and health monitoring forms to ensure they were person-centred and fully reflected people’s care needs.

Staff were appropriately recruited to ensure people were suitable to work at the service and there were sufficient staff to meet people’s needs. People’s medicines were safely managed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 July 2021) and there were four continued breaches of regulation in relation to Safe care and treatment, Nutrition and hydration, Person-centred care and Good governance. Continued conditions were applied to the provider's registration. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

At this inspection we found the provider was no longer in breach of Regulation 9 (Person-centred care) and Regulation 14 (Nutrition and hydration) but there were continued breaches of Regulations 12 (Safe care and treatment) and Regulation 17 (Good governance). In addition, we also identified a breach of Regulation 15 (Premises and equipment)

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make further improvement. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gabriel Court Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified two continued breaches in relation to provider oversight of the service and people receiving safe care and treatment. We have also identified a breach in relation to the maintenance of the environment at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Gabriel Court is a residential care home providing personal and nursing care for up to 44 older people including those living with dementia and mental health. At the time of the inspection 37 people were being supported.

People’s experience of using this service and what we found

The recording of care tasks required improvement. We found multiple gaps in the repositioning records and food and fluid charts.

Systems and processes were not in place to ensure unexplained bruises and injuries were investigated, monitored and audited to identify possible causes and to look for trends and patterns.

Cleaning schedules had multiple gaps in the recording. We found no evidence of high touch areas, shared equipment and shared rooms being cleaned consistently.

Where people did not meet their fluid target for days/weeks, there was no record of any action taken. There was no record of meals being fortified or provided in a different consistency as required to reduce risk.

We identified that some staff had not completed their mandatory training within their induction period. The training matrix showed some staff were out of date with their refresher training.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the systems in the service did not always support this practice. Records evidenced, at times relatives had signed consent documents with no legal powers to do so.

Systems and processed were not in place to audit daily care tasks, call bell response time, cleaning schedules and information recorded within people’s care plans and risk assessments.

People’s preferences were not always recorded in their care plans. This included whether people preferred to be supported by male or female carers for personal care.

Medicine administration records (MAR) were in place and people's medicines had been administered as prescribed.

Where complaints had been received, these had been appropriately actioned and responded to.

People told us that staff respected their privacy and dignity and choices, and described staff as ‘brilliant’, ‘good’, ‘kind’ and ‘considerate’. People told us they felt safe.

Rating at last inspection (and update)

This service was previously rated Inadequate (published 05 June 2020). Nine breaches of regulation were found at this inspection in relation to safety of the environment, safeguarding, staffing, nutrition, consent, respect, person centred-care, complaints. This resulted in conditions being applied to the provider’s registration. At the last inspection, we looked at safe and well led only and rated the service as requires improvement (published 27 August 2020) and although some improvements had been made, breaches of regulation and conditions remained in place.

At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gabriel Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified four continued breaches in relation to risk management, person centred care, nutrition and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. The provider will submit an action plan every month detailing what they will do to improve the standards of quality and safety We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Gabriel Court is a residential care home separated into two units providing personal care to up to 44 people. One unit is the lower dependency unit and the other is the higher dependency unit, where people with more advanced dementia are cared for. At the time of our inspection there were 38 people using the service.

People’s experience of using this service and what we found

Medicines were not always safely managed. As a result, three people had not received their medicines as prescribed and stock control systems required improvement.

The provider had quality control systems in place, however they were not always effective as records were not always correct and audits had not always identified errors in records.

There were enough skilled and experienced staff to meet people’s needs. Staff were adequately trained and had regular competency checks. Staff told us that they felt supported by the management team.

People’s individual risks were managed in a safe way and staff knew how to protect people from the risk of harm and abuse. Risk assessments were completed appropriately, for example around nutrition, pressure sores and mobility.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was inadequate (published 5 June 2020) and there were breaches of nine regulations. We placed conditions on the provider’s registration whereby they were required to send monthly reports on the improvements they had made. At this inspection improvements had been made, however the provider was still in breach of regulations so the conditions remain in place.

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, moving and handling practices and wound care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Gabriel Court Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to the management of medicines and the accuracy of records at this inspection. We also found that when the provider identified that improvements were needed, action plans were not always created to evidence that the required improvements were being addressed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to receive monthly reports from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, the service will remain in 'special measures', as whilst the ratings in the Safe and Well-Led domains have improved from inadequate to requires improvement, the rating in the Effective domain remains as inadequate. This means we will keep the service under review and we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Gabriel Court Limited is a residential care home for up to 44 older people living with dementia. At the time of inspection there were 40 people living at the home.

People’s experience of using this service and what we found

There was a registered manager who had been the manager of the service since it registered with CQC in October 2010.

The provider failed to have adequate systems to assess, monitor and mitigate the risks to people’s health, safety and welfare. The provider had not kept up to date with current legislation to keep people safe.

The provider failed to have systems and processes to assess, monitor and improve people’s quality and safety of care. They failed to have quality monitoring of all areas to identify where people were not receiving care that met their needs.

The provider failed to have systems to safeguard people from abuse or improper treatment. People were not always treated with dignity and respect.

People, their relatives and representatives had not been involved in the planning of their care. People’s feedback and complaints had not been used as learning or used to improve the quality and safety of care.

There were not enough skilled and experienced staff to meet people’s needs. Staff were not adequately trained, and their competencies had not been checked. Staff did not receive the support and supervision they required to carry out their roles.

The provider failed to update peoples’ risk assessments and care plans regularly or as their needs changed. They failed to have a safe handover system to ensure staff had information about people’s current needs.

People did not always receive food and drinks in a safe way or that met their needs. People did not always receive care that had been recommended by health professionals or receive their medicines as prescribed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People had access to indoor and outdoor communal areas. Staff were recruited using safe recruitment practices. Staff understood when to seek medical advice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 26 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified nine breaches of regulation in relation to safety of the environment, safeguarding, staffing, nutrition, consent, respect, person centred-care, complaints and governance. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Gabriel Court provides accommodation and personal care for older people, including people living with dementia and who have physical and mental health needs. The service can accommodate up to 44 people. At the time of our inspection there were 43 people living at the home.

At the last inspection, in August 2015, the service was rated Good. At this inspection we found that the service remained Good.

People were treated with respect, kindness and empathy; they had developed positive relationships with the staff that were caring. People had detailed personalised care plans in place which enabled staff to provide consistent care and support in line with people’s personal preferences.

People continued to receive safe care. Staff were appropriately recruited and there were sufficient staff to meet people’s needs. People were protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision, training and on-going professional development that they required to work effectively in their roles. People were supported to maintain good health and nutrition.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice. There were a variety of activities available for people to participate in if they wished to.

The service had a positive ethos and an open culture. The registered manager and provider were committed to develop the service and actively looked at ways to improve the service. There were effective quality assurance systems and audits in place; action was taken to address any shortfalls.

People knew how to raise a concern or make a complaint and the registered manager had implemented effective systems to manage any complaints that they may receive.

Care staff we spoke with told us that they had undertaken a thorough cleaning of the home since our last inspection. The cleaner told us, 'We now have a revised programme that makes sure the home gets a thorough clean at least once every month.'

The owner told us that the home had its own deep cleaning equipment and had a dedicated person to operate this equipment.

The provider had taken adequate steps to ensure the home was clean and we found all areas of the home clean.

When we visited the provider told us that they did not carry out diagnostic and screening procedures or treatment of disease, disorder or injury. We have advised the provider to have these regulated activities removed if there is no intention to provide these.

A health care professional who visited the home regularly said, 'We work very closely with the care team here and they are attentive towards people's needs and work with us closely in maintaining their health needs.'

People's care plans were detailed and took account of their individual needs. We found that the provider had made the improvements we asked them to make at our last inspection on 14 December 2012 and had made sure that the immediate needs of people who came to live at the home more recently had been assessed and met in a timely way.

We found that the provider needed to make improvements to the way the home was cleaned and maintained.

The provider had adequate quality assurance systems to ensure the safety and comfort of people who lived at the home.

When we visited the provider told us that they did not carry out diagnostic and screening procedures or treatment of disease, disorder or injury. We have advised the provider to have these regulated activities removed if there is no intention to provide these.

People's care plans were detailed and took account of people's individual needs and how this would be supported. However we found that the provider needed to make improvements to ensure that the immediate needs of people who came to live at the home more recently were assessed and met in a timely way.

We found that the provider took adequate steps to protect the people they cared for and their carers from harm. The provider had adequate quality assurance systems which made sure the safety and comfort of the people they cared for were maintained and any problems quickly resolved.