Kettering care home rated inadequate and placed in special measures after failing to improve enough

Owners of Gabriel Court in Broadway had previously had action taken against it by the CQC to protect residents by imposing conditions on the home.

But the home failed to improve enough at the latest inspection in May 2024, and has been placed into special measures after inspectors found several concerns with the quality and safety of people’s care, including three breaches of the legal regulations in relation to safe care and treatment, staffing and governance.

Craig Howarth, CQC deputy director of operations in the Midlands, said: “When we inspected Gabriel Court, we were concerned to see a lack of strong leadership and a culture that didn’t encourage high-quality care.

"This was affecting people using the service as there weren’t effective processes in place to enable staff to provide safe care.

“Staff were putting people at risk of injury from poor moving and handling practices. We alerted the manager; but they didn’t take immediate action to ensure all staff knew how to do this safely. The manager later carried out spot checks and spoke with staff about safe moving and handling.

“We found people experienced falls which weren’t always accurately recorded or investigated to prevent further falls and people’s risk assessments and plans hadn’t always been updated to reflect those risks.

“Leaders didn’t have an effective system to ensure people being admitted to the home had their risks assessed, or care plans created to ensure staff knew how to care for people’s individual needs. We told leaders they needed to address this as a priority.

“A new manager was in post at the time of the inspection. They have the information from our report which we expect them to use to make rapid and widespread improvements.

"We’ll continue to monitor them closely to keep people safe while this happens.

"We will return to check on their progress and won’t hesitate to take further action if people are not receiving the care they have a right to expect.”

Gabriel Court is run by Gabriel Court Limited, with the capacity to provide accommodation and personal care to up to 44 people. At the time of the assessment there were 34 people using the service.

The inspection was prompted in part to follow up on concerns CQC identified following the previous inspection.

During this inspection, CQC found several concerns with the quality and safety of people’s care and identified three breaches of the legal regulations in relation to safe care and treatment, staffing and how they were managing the service.

As well as the service’s overall rating going down from requires improvement to inadequate, so have the ratings for being safe and well-led.

On this occasion, the CQC did not inspect how effective, caring and responsive the service was, as it focused on the specific areas of concern – they remain rated as ‘good’ from the previous inspection.

The service has been placed in special measures, which means it will be kept under close review by CQC to keep people safe while Gabriel Court makes the improvements they have been told to. If there are not rapid and widespread improvements, CQC may look to use their regulatory powers further.

Inspectors gave the home a rating of 34 per cent in the ‘safe’ category and in the ‘well-led’ category 32 per cent.

They found:

– The process for recording incidents and accidents was not effective and did not contain all the relevant information needed to learn from these.

– The lack of a stable management team was described as a very unsettling time for individuals who lived at the service, and the staff group.

– Safeguarding and whistleblowing policies and procedures were not always followed in practice and did not contain clear guidance with contact details on how to contact other organisations.

– People were not always protected from unsafe environments.

– People did not always receive their food and drink to meet their needs.

– Staff did not always complete accurate or detailed care records.

However:

– People told inspectors they found staff to be kind and caring and felt safe with them.

– People told inspectors if they didn’t feel safe, they would speak up to either a family member or the home manager.