The Gables

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People continued to experience variation and inconsistency in the standard of care expected. There was still a breach of regulations in relation to consent. People experienced an inconsistent approach to seeking their consent to their care. Staff had not always ensured legal requirements had been met where people lacked the capacity to consent. Not all staff had completed the relevant training in this area and not all staff were able to demonstrate their understanding of the legal requirements. People’s care plans whilst in place, did not always contain sufficient detail, nor were they always sufficiently personalized. People’s communications needs especially where they lived with dementia did not sufficiently reflect how they communicated non-verbally, and how they could be supported to make decisions. Staff had not always read people’s care plans. People lacked sufficient choice in the meals provided. People could ask for alternatives, but this required them to be aware there was an alternative menu. Staff did not have access to a central record of all people and their diagnosis, in the case of an emergency. Staff had not always received relevant training to support people to live healthier lives. However, people had seen health care professionals such as the GP and dentist. The interim manager was starting to take action for people. They were about to bring in an electronic care planning system which will make it easier for staff to access and read people’s care records. They were also planning actions to improve the choice of meals for people.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People we spoke with could not recall having been shown their care plan or any information about their care needs. People said the care they received from staff was good, but they were unsure if all staff were familiar with their specific care needs. A person commented, “I’ve never seen my care plan so I can only say I get care which seems ok.” However, some relatives told us they had been involved in their loved one’s care planning and reviews, whilst others said they had not.

Staff told us they had not been told to read people’s care plans, nor did they have the time to do so. However, staff told us they knew people’s care needs well, through caring for people, speaking with them and information shared at staff shift handovers. The interim manager told us each person now had a full set of care plans in place, which showed if they or their relatives had been involved. They also said they were about to bring in an electronic care planning system, which will make it easier for staff to access information about people’s care needs. Staff told us they had been asked for their views to inform people’s reviews of their care.

People had an initial assessment of their care needs, but limited information had been recorded and they were not always dated to indicate when they had been completed. People’s care plans sometimes lacked sufficient detail and personalization. A person’s sleeping plan covered their practical care needs in relation to sleeping. However, it did not include details of their likes, preferences and routine, to inform staff what made a good night’s sleep for them. We saw 2 people’s communication plans contained a lot of identical wording, rather than personalized comments. People’s communication needs had not always been fully assessed and met to maximize the effectiveness of their care. A person’s communication plan noted they were living with dementia and stated they could not communicate their choices verbally and staff anticipated their needs for them. However, there was a lack of written guidance for staff about how the person might communicate non-verbally, through their body language, eye movement and gestures. We observed at lunchtime the person was physically leaning forwards in their chair, watching the corridor from the kitchen where staff would bring their lunch from, intently. The person’s body language was communicating they were keenly anticipating the arrival of their lunch. However, people's needs had been assessed in relation to a range of care needs. Their needs had been identified, what they could do for themselves, and any support required.

Two other relatives told us they had concerns about how often drinks were offered to people or whether staff supported people to have their drink, or if they just removed drinks which were not drunk. People spoken with all said there was no choice of menu at any of the meals. A relative said they had raised the lack of choice and been advised this was being addressed. However, people and relatives were happy with the meals provided overall. They felt there was sufficient food available to people when they wished. Some people said they could refuse a meal and something else would be provided. A relative told us how their loved one had put on weight and how staff weighed their loved one regularly.

Staff confirmed the menus provided people with one option for the main meal at lunchtime and one pudding. At teatime there was one snack option followed by cake. Staff told us if people did not want the menu option offered, then there was an alternative menu, if people asked. People could also ask for favorite dishes. Kitchen staff were informed of people’s food preferences. However, the interim manager informed us they would be reviewing the range of meals provided for people in order to make improvements and provide more options. The interim manager also told us nationally recognized tools were in use in order to assist with identifying people’s needs. The interim manager told us they kept themselves up to date with current legislation and standards. They appreciated the need to support the staff team in order to develop their knowledge and understanding.

There were not processes in place to support people living with dementia to understand what the lunch was going to be. We did not see a pictorial version of the menu to assist people. In order for people to request an item from the alternative menu, they needed to be aware it existed. There was no pictorial information to inform people. A person’s care eating care plan noted they were not very particular about what they ate. However, it did not state their food preferences, what they used to like, whether they were vegetarian or had any specific religious requirements in relation to their diet. There was a lack of written information in their care plan to inform and guide staff. People’s records contained tools staff had used to enable them to assess their needs and these were reviewed regularly. However, people’s assessed level of risks were not always consistent across the tools used and their records. A person’s records said they were underweight, but their malnutrition universal screening tool (MUST) score was 0 which indicated they were at low risk, their records were conflicting. This created a risk staff would not provide them with the correct care.

Relative’s felt overall staff worked well together to support people. A relative confirmed staff worked together to provide their loved one’s care. This included making any arrangements for people to see their GP.

Staff told us there was not a handover sheet in use to ensure there was an up-to-date list of people and their diagnosis in the event people needed to be transferred to another service quickly. There was not a robust process in place to enable the sharing of information. Staff also said they were not always provided with full information from services about people before they were discharged back into their care. Therefore, staff may not have received all of the relevant information to enable them to support people appropriately.

Partner agencies told us further work was required to ensure the staff team worked effectively, both together and with external services. They felt further work was required to enable the delegation of more tasks to staff.

People's information was shared with staff via the 'important information record' and the staff handover. Information about risks to people and their care needs, for example the need for people to be referred to the SaLT for assessment had not always been made in a timely manner.

Overall relatives were satisfied people were supported by staff to live healthily. A relative confirmed staff had ensured their loved one had dentist visits.

Staff told us they had not always received the relevant training to enable them to support people to live healthier lives. Staff told us they had not all received training in diabetes or dementia care although people at the service were living with these conditions. Staff also said they had not received training in common health conditions such as urinary tract infections, to ensure they understood the signs and symptoms to be aware of and the actions they should then take.

People had health and well-being plans and their care records contained information about their diagnosis to inform staff. We saw people had oral care plans and risk assessments in place which identified their care needs in relation to their oral care and how these were to be met. People had seen the dentist, or a specialist dentist where required. There was evidence people had seen their GP and the practice nurse.

We could not collect the evidence to score this evidence category.

We could not collect the evidence to score this evidence category.

We could not collect the evidence to score this evidence category.

Relatives provided mixed feedback regards whether they had been consulted and their views sought where their loved one was deemed to lack the capacity to make a specific decision. Overall relatives reported they had not been consulted by staff for their views about what was in their loved one’s best interests. However, some relatives spoken with said they had been consulted and their views sought as legally required. There was an inconsistent approach to consulting people’s relatives where legally required.

Staff spoken with demonstrated a basic understanding of the MCA 2005 overall. Care staff understood the need to seek verbal consent from people before they provided their care. However, not all staff were familiar with the principles and codes of conduct related to the MCA 20025 and able to apply them as required for people they cared for. Staff training records showed not all staff who needed to complete this training had done so. Staff’s MCA 2005 training had not been fully effective.

Staff had not either sought people’s consent where people shared a bedroom. Nor if they had reason to believe people lacked the mental capacity to make this decision, had they ensured legal requirements were met. Staff had not ensured where people had a Power of Attorney in place to authorize an attorney to make decisions on their behalf, that they could demonstrate the required checks had been completed. To ensure its validity and the type of decisions the attorney was able to make. Staff are required under the MCA 2005 to ensure discussions about consent with a person are conducted in a way which meets the person’s communication needs. Staff had access to limited information in people’s care plans about how they communicated non-verbally and how they could be supported to make decisions. People who had the capacity to make specific decisions in relation to their care had not always been asked to sign their consent to their care plans. A person whose records were reviewed had not been asked to sign their consent to their care plans. However, we saw evidence some people had been asked to sign their care plans. There was an inconsistent approach to seeking people’s written consent with regards to their care plans.