Gables Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service has been rated inadequate. We found breaches of regulations in relation to safeguarding people from harm and abuse, duty of candour, and a continued breach in good governance. Safeguarding concerns raised by staff had not been acted upon and documentation was not available to show us what actions had been taken in response to notifiable safety incidents. Medicine care plans were not always sufficiently detailed or up to date. There were enough staff to meet people’s day to day needs however they had not been sufficiently supported by the provider. A significant number of staff had not attended support meetings and there was no evidence staff meetings had taken place.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were generally happy with the care provided however their experience was affected by the lack of oversight and organisational learning. People had completed a survey in January 2024 providing feedback. However, their concerns around knowing about their care plan, for example, had not been acted upon. A residents’ and relatives’ meeting had taken place in January 2024, where feedback around menu planning and maintenance of the building had been raised, but again, no feedback had been provided to the people living at the home or their relatives.

Staff described morale at the home as being low with some staff feeling communication was poor which had resulted in feelings of uncertainty about the future. A staff survey completed in March 2024 provided a range of information in relation to culture and learning. However, this was not acted upon until June 2024. The leaders said they were aware of a negative historical culture which they felt now needed to be addressed through the use of Human Resource procedures.

There was a failure to listen to concerns about safety, learn, and take action to embed good practice. Notifiable safety incidents had been identified, however, there were no records confirming Duty of Candour processes had been followed. Concerns had been overlooked and had not been used to identify and manage risks. Incidents and complaints had been recorded, however, there was limited evidence this had resulted in changes that improved care for others.

There was little or no evidence people were involved in their care to minimise or manage any risks they were exposed to. During the assessment some people were moving from the home due to the closure of the nursing unit. However, there was a failure to document any meetings with people and relatives to show how they had worked jointly with them to maintain safe systems of care and ensure continuity of care when people moved between services.

Staff were aware of people’s needs. However, they said they were not involved in developing risk management plans and did not know how people were involved in managing risks. The registered provider acknowledged that further work was required in relation to care records.

Partners shared concerns in relation to safe systems and commented that whilst the home was open to working with partners, they were unable to maintain safe systems of care even with the support, advice and guidance of numerous professionals.

Systems, pathways, and transition planning had not been established and embedded into practice. Hospital information records had not been completed for 19 of 22 people who were resident during the assessment. People’s basic medical and personal information was not documented, meaning, if a person was admitted to hospital, this information would not be immediately available. Care plans contained limited information about people’s preferred care and how to support them safely.

People told us they would feel comfortable raising queries or concerns about their care. However, the assessment evidenced their feedback was not consistently acted upon.

Staff said they were aware of policies and procedures in relation to safeguarding and they would raise concerns, which they were confident would be dealt with. Some staff had raised safety concerns within support meetings in relation to moving and handling, staff approach, and staff sleeping on night shift. However, there was no evidence of any action having been taken to investigate or share the concerns appropriately. We spoke to the peripatetic manager who told us, “With regard to the safeguarding concerns which you identified, I have spoken to the staff, and they either can’t remember or don’t want to tell. Therefore, I am not sure if I can raise a safeguarding at this time as I don’t know which staff or residents were involved or the date the allegations refer to. We will be undertaking training with the Heads of Departments and senior care staff in development and supervisions.” The Commission subsequently raised these concerns with the Local Authority safeguarding team. The provider had failed to ensure concerns were listened to, reported, investigated, and acted upon to ensure people were safe good practice and learning.

We observed staff were attentive when supporting people and did not see any concerns in relation to how staff supported people.

Systems to safeguard people were not in place. Processes had not been implemented to protect people from avoidable harm and neglect. Staff had raised multiple concerns within support meetings yet there was no evidence action had been taken to explore the allegations further. There was no evidence staff meetings had taken place to discuss what it meant to keep people safe, and what procedures to follow if they were concerned. The safeguarding vulnerable adults policy was issued in May 2021, with a review date of May 2023. However, there was no evidence it had been reviewed within the set timescale. The provider was aware policies and procedures were overdue for review but had not acted to address this. Safeguarding adults training stood at 86% and safeguarding children at 88%. We were not assured systems were in place to safeguard people from bullying, harassment, abuse, discrimination, avoidable harm, and neglect. Concerns had not been shared appropriately or acted upon, meaning people were at risk.

People were not involved in the management of risk. There was nothing documented to show people and their relatives had been involved in the assessment and management of risks, or in care plan reviews. The residents’ survey from January 2024 indicated areas for improvement including care staff explaining things to people, people knowing about their care plan, people being involved in decisions around their care, and knowing about healthcare. No action had been taken in relation to this feedback.

Staff told us they had not been involved in care planning or risk management. We spoke with leaders about how people were involved in care planning. They said, “You can text type in the care plan that people have been involved and preferences have been taken into account. This isn’t being documented at the minute, but it’s part of the process.”

We observed staff supporting people in an appropriate manner and involving them in day-to-day decisions. Whilst these discussions may have included low level areas of risk, there was no evidence people were consistently and effectively involved in risk management. We observed that one person locked their door from the inside and staff had to unlock it when undertaking the morning medicines round. There was no information in care plans or risk assessments relating to this and no evidence this action had been discussed with the individual.

A process to involve people, and their relatives in the assessment and management of risks to ensure people's needs were met in a safe and supportive way, and which enabled them to do the things that were important to them had not been implemented. Care records did not evidence any inclusion in reviews and there was no evidence people or relatives had been involved in key decisions about using sensor equipment, in line with the Mental Capacity Act. Risks to people’s health and wellbeing had not been appropriately assessed and strategies had not been put in place to minimise risks. This included risks in relation to nutrition and hydration, diabetes care, mobility needs, and medicine management.

People commented they were happy with the environment, although noted some improvements could be made. A relative told us, “It’s just the environment could do with a lick of paint, maybe brighten the home up. [Person’s] room could do with a spruce up, the curtains have been hanging down off the hooks. The care home is tired and could do with decorating.” Other relatives also commented that the décor needed to improve.

There were mixed views about the environment ranging from, “The home needs a good decoration but I’ve no concerns about safety” to “It’s well maintained” whilst another staff member said “It [the environment] could be improved upon.”

Potential risks in the environment were noted during the assessment including people having access to a cleaning trolley which had been left unattended in an unlocked bathroom. People also had access to bottles and cans of alcohol, and an unknown green liquid, which had been decanted into a glass and placed in a cupboard under the sink in an unlocked kitchen.

Systems and processes had not been fully implemented to detect and control potential risks in the environment. Relevant servicing of equipment had been completed. There was limited evidence that audits had been used effectively to detect and control potential risks in the environment, however, environmental improvements were detailed on an action plan. The fire service had issued a fire safety order and action to address the issues raised was taking place during the assessment.

People and relatives had mixed views about staffing, with some saying there were enough and others commenting there were not. One person said, “Generally speaking I think its quite consistent, there’s the odd one I don’t like so much but I talk to everyone.” Another person said, “No, I don’t feel there is enough staff. I have raised this with management, which they have acknowledged but then nothing seems to happen.”

Staff also had mixed views, with some commenting there were enough staff, another saying it was adequate, and one stating there were not enough staff. Staff said they had the training they needed to fulfil their role, although it was completed online mainly. Some staff felt they were supported by management, and this had improved recently, but others said they did not feel very supported at all.

We observed there to be enough staff to support people and to meet their day-to-day needs, including one person who was receiving nursing care, with a nurse on site to provide the care and treatment needed. However, the provider had not ensured the consistent provision of effective support, supervision, or development by way of regular one to one support meetings. This meant improvements needed to be made to ensure staff were effective.

Processes were in place to ensure the safe recruitment of staff. However, we found gaps and contradictions in recruitment records, including references not being obtained in line with the provider’s own policy, the reasons people had left a previous post was not always recorded, and there was some contradictory information in application forms. We discussed this with the operations manager who said, “It’s just sloppy isn’t it.” Whilst action had been taken to seek explanations for omissions and conflicting information there was no evidence a satisfactory response had been received. There had been no staff support meetings documented as having taken place since our last inspection in October 2023 until February 2024, which was not in line with the provider’s policy. During February and March 2024, 21 staff had attended a support meeting, leaving a further 17 staff with no documented support meetings. Furthermore, the provider was unable to evidence staff had received support in staff meetings as no minutes were available.

People and relatives told us the home was generally clean and tidy saying, “Oh yes, very clean and tidy. Staff wear the Personal Protective Equipment (PPE).” People were supported by staff who had attended Infection Prevention and Control (IPC) training.

Staff told us they had access to PPE and wore aprons and gloves appropriately. The provider acknowledged IPC audits had not been effectively implemented to ensure oversight and address any concerns.

We observed poor practice in relation to food storage and kitchen hygiene. Opened foods had not been appropriately labelled or stored hygienically. We brought this to the attention of managers at the home and they took immediate action to address this shortfall.

Processes were in place to assess and manage the risks of infection, however, they had not been effective in relation to food hygiene. A kitchen audit completed in April 2024 found no concerns with food storage or rotation. However, the audit was later updated to say stock rotation was not in place and many food items were out of date and had been disposed of. The action plan stated daily checks were to be implemented. However, we identified some out of date foods during our assessment. We spoke with the peripatetic manager who commented no one had told them the audit had been rescored, so daily checks had not been implemented. IPC audits had been completed and evidenced a significant decline in IPC practices between January 2024, when the audit rating was good, and May 2024, when it was inadequate. A 44-point action plan had been produced which detailed the shortfalls and the action to be taken, alongside who was responsible for making the improvements. However, there were no target dates for completion of actions, meaning the provider had no expectation for when improvements should be made.

Processes for applying and recording creams were in place. However, we found these was not being consistently followed by staff. One person was not having their cream applied as prescribed and for other people records were not accurately completed. Medicine Patch application records were not available for one person to demonstrate rotation to prevent side effects. A process for ensuring people received time sensitive medicines at the right time was in place. However, one person on medicines for Parkinson’s disease did not get their medicines at the prescribed time. For some people information to support staff to safely give ‘when required’ medicines were in place. However, we found for several people these were not person centred, and for some people plans were missing. We observed part of a medicine round and people received their medicines respectfully.

Staff told us they had completed medicines training and had been recently assessed. Managers told us about the variety of medicines audits; however, these had not identified all the issues we found.

Records of regular medicines followed national guidance including recording people’s allergies. However, managers had identified that stock did not balance with records, and stock adjustments had been made on the electronic medicine record for several people and medicines, showing the records were not correct. Care plans for medicines were available. However, these were not up to date and did not have sufficient information to ensure the safe use of medicines. Processes were in place for supporting people who needed their medicines given covertly, hidden in food or drink. However, this was not fully documented for one person. Comprehensive policies and procedures were in place to support the administration of medicines. However, these were not always followed by staff. Medicines were stored securely and safely including controlled drugs.