Gables Care Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

The service has been rated requires improvement. We found a breach in relation to person-centred care and a continued breach in relation to governance. The provider had not implemented effective systems to ensure care and treatment was appropriate, met people’s needs and reflected their preferences. Staff reported feelings of low morale and had not been afforded regular opportunities to discuss their wellbeing, raise concerns, and suggest ways to improve the service. Where staff had raised concerns, leaders had failed to provide a timely and considered response.

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were kind and compassionate in their approach. One person said, “If there is anything I need they are always there. I just have to shout for help.” A resident survey had been completed in January 2024 and, whilst this had not been responded to by the provider, feedback about staff was positive, including that staff knew people well and were polite and respectful. However, people’s experience was impacted by a lack of managerial governance and oversight to maintain safety, effectiveness, and quality of care.

The activities co-ordinator had signed up to be a dementia friend outside of work and said they had used lots of the support materials to help in their work and spoke about the importance of taking time to get to know people. Staff were positive about their role. One staff member said, “ I love it here. I’ve done care since I was 16 years old. Caring is my passion.” Another said, “I really love the service users and having a natter on with them. We have laughs every day.” However, due to the concerns identified during the assessment in relation to care planning we could not be confident in the providers approach.

Partners shared positive feedback about individual staff members, however, felt omissions in care continued to place people at risk, meaning they were not always shown kindness, compassion, and dignity. Other feedback indicated care home staff were compassionate and kind. However, it was felt management had attempted to blame the home’s situation on care staff, rather than accepting responsibility.

We observed staff to greet people respectfully, and treat people with kindness and compassion, actively engaging with them in meaningful conversation and encouraging people to take part in activities. There was positive and appropriate use of touch, as both encouragement and reassurance. However, due to the ongoing concerns since the last inspection, and the findings at this assessment, we could not be confident in the provider’s approach.

A residents’ survey completed in January 2024 showed people felt staff treated them as individuals. However, there was limited evidence in care records of people’s individual needs and preferences, and how staff should support people to maintain their individuality.

Care staff told us, “We show people respect and listen to them” and “I treat people how I’d want to be treated.” Another said, “We treat people with respect as they are individuals.” However, information to support staff to ensure people’s needs and preferences were met was limited.

Staff appeared to have a good understanding of people’s needs and understood people as individuals. We observed friendly and appropriate exchanges throughout the inspection.

Processes were not in place to make sure people’s care, support, and treatment met their needs and preferences. Care plans were not individualised, were poorly completed and tended to include broad statements rather than 'I' statements which were individualised to the person. We saw no information on people’s culture or aspirations, and information relating to people’s communication needs, to enable them to fully engage in their care and support, was limited.

People told us they had choice and control. Comments included, “Yes, definitely, my voice is definitely heard.” Feedback from the residents’ survey in January 2024 was that the staff team encouraged independence, offered choice and gave people time to make decisions. However, due to the lack of evidence people had been included in care planning and reviews of their care, there was limited evidence people understood their rights and had the opportunity to have control over their care, treatment, and wellbeing.

There was limited evidence staff had received guidance on how to promote people's rights to have choice and control over their own care, treatment, and wellbeing. Care staff did not know how people, or their representatives were involved in the development of care plans, other than one staff member who said, "People tell us their likes and dislikes so we write it in." Another staff member said, "We are not involved in care planning or feeding into them, the seniors do it. We've been told care staff are not to do care plans, but I think there'd be benefit if we could do them." Leaders told us they knew care plans were not individual but were working on getting things added to the electronic care planning system and they intended to review care and make it more individual later.

We observed staff treating people kindly. However, people’s rights were not always discussed and respected in relation to choice and control over their care and wellbeing. For example, in relation to the involvement in care planning and the use of sensor mats.

People’s independence, choice and control was not always supported. There was no evidence people had been involved in decision making in relation to the placing of sensor mats in rooms. It is a requirement of the MCA that people are involved in decision making in relation to the use of sensor mats, if at all possible and in a manner that meets their needs and comprehension. Care plans were poorly completed and did not always contain information about people’s choices, such as how they wished to receive personal care. Care plans detailing personal care needs were in place, however, they concentrated on oral care, and information recorded was generic in nature. Communication and emotional support care plans were poorly completed and did not provide staff with the detail needed to make sure they communicated with people effectively and to ensure they understood their rights.

People had mixed experience of their immediate needs being met. One relative said, “Yes definitely they make me feel my loved one’s wishes are a priority.” People said, in relation to whether their needs, views, wishes and comfort was a priority, “I don’t always feel like it’s a priority” and “No, I don’t think I feel like a priority to the staff here.”

Staff told us they spoke with people and listened to their views to make sure they could meet their immediate needs.

Observations indicated staff had a good understanding of people’s requirements and looked to address their immediate needs. Staff responded well to call bells, although we did not one that rang for approximately 5 minutes. One person pressed their call bell to demonstrate that staff responded to their needs quickly. In the lounge area we observed staff engaging well with people responding to their emotional needs and ensuring people were safe when they got up to walk around the home. During mealtimes we observed people needing support with meals were assisted safely and appropriately.

There was mixed feedback about staff support and opportunities for staff to share feedback, raise concerns, and suggest ways to improve the service. Some staff said they felt supported by the current management team, however, the majority of staff said staff morale was low. Comments included, “Morale is low due to uncertainty” and “Morale is low. There aren’t really any communications and no staff meetings.” They added, “More communication is needed and staff involvement.” Staff surveys had been completed in March 2024 and included a significant number of areas for improvement. However, leaders had not provided a timely and considered response to the feedback. Some staff had attended support meetings with a manager during February and March 2024, and had raised some concerns, but action had not been taken to address these concerns. Some staff had received no support meetings, to discuss their wellbeing or provide an opportunity to provide feedback, since the last inspection in October 2024. There was no evidence of wider staff meetings having taken place since the last inspection. Leaders said morale had improved a lot recently and felt there had been a change in communication, with leaders being open and honest. They said, “We know staff meetings have taken place, but they haven’t been recorded.” When asked about workforce wellbeing they said, “Unfortunately it has fallen by the wayside and has been left, we are not giving 100% support, but it will improve.”

Whilst processes were in place to support staff wellbeing, they had not been implemented. The Staff Support, Development and Appraisal Policy stated staff should be offered, and attend, a minimum of 4 support meetings per year. Whilst some staff had attended one support meeting since the last inspection, a support meeting matrix evidenced 17 out of 38 staff had no access to personalised support or opportunities to share feedback, raise concerns, and suggest ways to improve the service. Staff had been asked for feedback via a staff survey in March 2024, during which staff had identified multiple areas for improvement, including team working, feeling their concerns were not dealt with, and not receiving helpful support and development meetings. No action was taken in response to the staff survey until June 2024, when an action plan was developed. However, it was not comprehensive and did not respond to all the feedback provided by the staff team.