Gables Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The service was now rated inadequate. We found a breach in relation to person-centred care and a continued breach of governance. People were not at the centre of their care. There was no evidence people were involved in any aspect of the care planning and review process. Care was not sufficiently joined up with partners saying issues were not always appropriately escalated and addressed. Communication care plans were limited and didn’t include detail on how people should be supported to access information and be involved in meaningful decision making. The providers oversight mechanisms had failed to ensure records were accurate and up to date and included information on people’s cultural needs and beliefs.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s experience of person-centred care was variable. The provider did not ensure people were at the centre of their care and treatment choices. The provider did not promote collaborative decision making when responding to any relevant changes in their needs. The lack of detail in people’s care records impacted their experience of care, as there was no documented evidence to indicate decisions were made in partnership with people.

Staff told us person-centred care meant, “Giving assistance when it is needed and encourage what they can do. Treat everyone as an individual.” Another staff member said, “I don’t know what you mean.” Leaders said, “Staff do provide person centred care but don’t realise that’s what they are doing, it’s just natural to them to do it. Staff certainly are giving it, whether it’s replicated in care plans is a different situation and we are working to make sure paperwork is person centred.” They added, “Staff have been upset with people leaving us, so do invest in the care of people” and “Staff have said [the electronic care planning system] is reducing time on paperwork and increasing more quality time with people. We are working on how to record and capture those social aspects of care.” Care plans did not support staff to deliver person-centred care.

Staff knew people individually, and we observed care, which was generally positive, with staff showing a patient and understanding approach. However, care plans lacked detail and some contained no information at all. Other information was generic in detail. For example, care plans for mobility regularly stated, ‘areas should be free from clutter and appropriate footwear worn’ with no reference to individual needs. Other comments included, ‘Staff to encourage well balanced diet and fluids’ and ‘Staff to offer support and assistance when required with any aspects of daily living.’ There was insufficient detail in relation to the support people needed and how they wanted to be supported. There was no evidence people and their relatives had been involved in planning and making shared decisions about their care, and records did not fully reflect people’s physical, mental, emotional, and social needs.

People’s experience was impacted as there was limited evidence in care records that care provision was integrated, and systems were in place to ensure continuity of care. People’s needs had not always been fully assessed, meaning care could not be delivered in a co-ordinated and responsive way as care records were not sufficiently detailed.

Leaders were able to describe how integrated care and continuity of care should work. However, in practice there was limited evidence care delivery had been considered in a wider context. Healthcare professionals were involved in people’s care. However, care records were not always accurate or reflective of people’s needs and preferences. Staff were not aware of processes for admission and discharge from the care home. One said it was, “The responsibility of the home manager, seniors and nurses,” whilst another thought it was “in risk assessments.”

Partners told us care was not joined up and issues were not appropriately escalated and addressed when they happened. For example, when medicines ran out, or when poor practice was identified. Partners did not feel care plans were effective in ensuring people received appropriate care and support. We also received feedback that recent discharges from the home, following the closure of the nursing unit, could have been managed better.

There was limited evidence in care records that care delivery had been considered in a wider context. District nurses were regularly in the home to carry out treatments and there was evidence that a GP and local pharmacist had carried out a review in relation to covert medicines. Records relating to other professional involvement were not always clear. One care record stated that dietetics had changed the type of diet supplements a person was prescribed. However, this was not borne out by other records. When we asked staff, they told us further changes had been made due to sourcing difficulties. Whilst the individual was getting the correct supplement records did not reflect this. Hospital passport information was not well completed. Some hospital transfer records were only 40% complete and many records were missing ‘Who I am’ information about people as individuals. Important information such as communication needs and DNACPR information had not been completed. Medical care plans contained limited information about medical conditions and no information as to when additional support should be sought.

People and relatives told us when they had first moved to the home there had been good information and communication, but this had lessened over time. People said staff did provide information to them, and comments included, “Yes, they do explain things very well” and “Yes, they make sure I understand what is happening.” However, people and relatives had not been provided with information following resident surveys or resident and relatives’ meetings. Communication plans were limited, and people had not been included in the planning of their care.

Staff told us they sometimes used hand gestures, like thumbs up, to communicate with people, or interpreted people’s vocal expressions. Leaders explained that information could be provided in different formats if the need arose. They said they had a number of staff whose first language was not English who could provide translation, if needed, and the new electronic care plan system had the capability to produce easy read documents. Leaders said there was an expectation that home managers analysed information and provided feedback, however, they could not evidence feedback had been provided following surveys and commented, “Systems are in place, but they have not been followed. There is a weakness in the production of minutes.”

Leaders said systems were in place to provide feedback and information, but they had not been followed. Individual communication care plans, which should detail people’s specific communication needs and preferences, provided minimal detail about how people should be supported to access information and make meaningful decisions. One person, who was broadly non-verbal, had a care plan that indicated staff should encourage increased use of hand gestures. However, there were no actions to show how this was to be done. This person also was said to communicate by various sounds, but there was no indication of how their various vocalisations should be interpreted. Another person was said to be able to hold conversations, but they were generally ‘not relevant.’ There was nothing about how to involve this person in meaningful engagement and activity. There was no clear evidence leaders had considered how best to present information to people to meet their individual needs. We requested an Accessible Information Standard Policy however this was not provided.

People told us the felt listened to and any concerns would be dealt with. One relative said, “I have made a complaint, and it was dealt with in a timely manner.” However, people had not been kept informed about how feedback given in residents’ surveys had been acted upon. There was no evidence people and their relatives had been involved in decision making about their care and whether any changes had been made as a result of any feedback or involvement.

Staff said if someone raised a concern or complaint with them they would, “Ask why the person was unhappy and get more information, tell a senior or a manager and record it on the electronic system.” However, concerns raised during surveys and resident and relatives meetings had not been listened to and acted upon.

A complaints folder was in place, and formal complaints had been dealt with appropriately and full responses given. However, there was also a comments book in the kitchen, in which comments about the quality of food had been recorded. There was no evidence these comments had been dealt with and action taken to address the concerns. Furthermore, people had provided feedback during a residents’ and relatives’ meeting held in January 2024 and a residents’ survey, also conducted in January 2024, but there was no evidence people had been informed how their concerns or issues had been addressed, nor had they been involved in sharing solutions and measuring outcomes and impact.

People’s experience was comprised as their care and support needs had not been fully assessed, care planned and reviewed. We could not be confident people could access care, treatment, and support when they needed it. One person said, “The doctor is not always accessible which can be annoying.” Another person said, “I did once ask to see the doctor. They told me it’s not possible but did not give a reason why.”

Staff said they would ensure people could access care and support, when they needed it, by supporting them 24 hours a day, as they are trained to do, and by responding to call bells and sensor mats. A staff member said, “If someone was poorly or had a fall, I would ring 111, especially if they were on blood therapy.” However, we found instances during the assessment where staff had not sought care or support for people when requested.

Partners shared concerns people were not receiving appropriate care as and when it was needed, in particular, in relation to the provision of specialist dietary needs and medicine management.

Staff had a good understanding of people as individuals, although without direct reference to care plans. Care plans were of variable quality and did not always identify and support the meeting of people’s needs. Communication care plans were often limited in their detail and did not always address how people should be supported, which would present barriers to people accessing support in a timely manner. Care records relating to hospital information were not fully completed or detailed. Some information was missing, or had not yet been added, in particular, Do Not Attempt CardioPulmonary (DNACPR) decision documents had not been uploaded to the system. Pertinent information about communication styles and needs, people’s preferences and wishes, which could be vital if someone needed to go to hospital, was often missing from records. Access around the home was generally good with all facilities accessible for wheelchairs, etc. The admissions policy was issued May 2018 and was due for review in May 2022 however this had not been completed.

The provider had sought information from people about their care and support by way of a residents’ survey and a residents’ and relatives’ meeting. However, there had been no follow up to this information and no evidence any action had been taken in response to people’s views. There was no evidence people had been involved in tailoring their care, support, and treatment to ensure equality in experience and outcomes.

Leaders said they had not analysed the results of surveys completed in 2024 and had not provided people, or staff, with any updates or ‘You said, We did’ information.

Processes were in place to seek information from people, but they had not been implemented effectively. Care had not been tailored to promote equality and protect people’s rights. The majority of people living at the home were elderly, many of whom were living with dementia. However, communication plans were limited and there was no information on how to involve people in expressing their needs and wishes, despite staff having attending training in dementia awareness and communication. Care records included care plans for ‘Sexuality.’ However, they were poorly completed, and in most cases not completed at all. Similarly, care plans for ‘Daily Life/Lifestyle’ did not reference any particular equality issues.

Care plans did not include specific detail in relation to life changes that were important to people.

We received very little feedback from staff in relation to how they supported people to plan for their future, however one staff member did say, “In the past we used to do that.” No one at the service was receiving end of life care at the time of the assessment, care plans did not include detail on important life changes.

The nursing care element of home was in the process of closing during the assessment, and people with nursing needs were moving out of the home. Leaders told us they had decided not to cancel the nursing element of the regulated activity they provided. However, they could not share a robust strategy for developing the service, so nursing care could be provided in the future, to ensure people’s needs could be met safely and appropriately. Care records did not include detail on supporting people with life changes which were important to them, including making informed choices about their future care and preferences for how they would like to be supported at the end of their lives.